Trends in mortality of pulmonary embolism--an international comparison

Evidence from several clinical and epidemiological studies suggests a decreasing incidence and mortality of pulmonary embolism (PE), but results are still controversial. We analysed time trends of fatal pulmonary embolism in several countries across Europe and North America.

We extracted age-, sex-, and country-specific number of deaths due to PE (415.1 ICD-9; I26 ICD-10) from 1980 to 2004 as available from the WHO mortality database, which comprises mortality data and population density in 5-year age groups based on national vital statistics. Yearly age- and sex-standardised mortality rates and their 95% confidence intervals for PE were calculated. We compared overall and sex-specific age-standardised mortality rates across different European countries and the USA over time.

Age- and sex-standardised PE-specific mortality in 1990 varied between 2.7/100,000 (2.5-3.0/100,000) in The Netherlands and 12.8/100,000 (12.0-13.5/100,000) in Austria. While in most countries PE mortality decreased over time, PE mortality increased distinctly in Poland from 4.0/100,000 (3.75-4.27/100,000) to 7.7/100,000 (7.45-8.03/100,000) in 2003. In Germany, we observed a continuous slight increase and in The Netherlands no clear change of PE mortality was seen.

While comparison of cause of death data over time and across countries should be undertaken with caution due to inaccuracies in assigning the cause of death and national conventions in coding, the general trend of a decline in PE mortality could not be shown in several European countries.