Disparities and trends in pulmonary embolism mortality with and without obesity: a nationwide US analysis

Obesity increases the risk of pulmonary embolism (PE) through multiple mechanisms.

This study examined mortality trends in patients with coexisting PE and obesity.

We analyzed the Centers for Disease Control and Prevention Wide-ranging Online Data for Epidemiologic Research database for individuals aged 25 years and older who died between 1999 and 2020 from concurrent PE and obesity. Temporal trends and age-adjusted mortality rates (AAMRs) were assessed using Joinpoint regression software. Annual percent changes (APCs), average annual percentage change differences, and 95% CIs were calculated, with statistical significance set at P < .05.

From 1999 to 2020, the AAMR for PE with obesity increased from 5.1 (95% CI, 4.7-5.4) to 13.9 (95% CI, 13.4-14.4) per 1,000,000. The AAMR rose significantly from 1999 to 2018 (APC, 3.45; 95% CI, 2.65-4.01; P = .005), followed by a sharper increase from 2018 to 2020 (APC, 16.28; 95% CI, 6.24-21.22; P < .001). Women consistently had higher AAMRs than men (8.8; 95% CI, 8.6-8.9; vs 6.5; 95% CI, 6.4-6.6). Among age groups, middle-aged adults had the highest AAMR (10; 95% CI, 9.8-10.1), while among the ethnoracial groups, non-Hispanic Black individuals had the highest AAMR (16.8; 95% CI, 16.5-17.2). Residents of nonmetropolitan areas had higher AAMRs than those in metropolitan areas (8.9; 95% CI, 8.7-9.1; vs 7.5; 95% CI, 7.4-7.6). The increase in AAMR was significantly greater for PE with obesity compared with PE alone (average annual percentage change difference, 3.61; 95% CI, 2.91-4.32; P < .001).

The analysis reveals a significant rise in mortality from concurrent PE and obesity, with higher rates observed in women, middle-aged adults, non-Hispanic Black individuals, and residents of nonmetropolitan areas. These findings highlight the need for targeted interventions in these high-risk groups.