Pulmonary embolism and diabetes-related-mortality in United States: temporal trends and epidemiologic shifts.
Pulmonary embolism (PE) and diabetes mellitus share an intertwined cardiometabolic pathway that contributes to poor prognosis and higher mortality among patients. However, national trends in PE-related mortality involving diabetes remain underexplored.
Mortality data were extracted from the CDC WONDER Multiple Cause of Death database (1999-2024) using ICD-10 codes I26 for pulmonary embolism and E10-E14 for diabetes mellitus. Joinpoint regression was used to estimate APC (Annual Percent Change) and AAPC (Average Annual Percent Change). A p-value < 0.05 was considered statistically significant.
Between 1999 and 2024, the co-recorded pulmonary embolism and diabetes on death certificates showed 82,241 deaths, with the most deaths being recorded at the medical facility (61.29%). The overall AAMR rose significantly from 1.08 in 1999 to 1.88 in 2024, with an associated AAPC of 1.98 (95% CI: 1.10 to 2.87; p < 0.001). Widening gender gaps were observed, where males demonstrated higher mortality throughout the period. In 1999, men had an AAMR of 1.11, while women had an AAMR of 1.05. In 2024, it was 2.19 (AAPC: 2.44; 95% CI: 1.45 to 3.45; p < 0.001) in males and 1.63 (AAPC: 1.46; 95% CI: 0.18 to 2.76; p = 0.02) in females. Non-Hispanic Black individuals had the highest AAMR in 2024, at 4.01 (AAPC: 1.29; p = 0.06), followed by non-Hispanic White individuals (AAMR: 1.73), Hispanic or Latino individuals (AAMR: 1.59), and NH Other (AAMR: 0.98). Rural areas had steeper increases (AAPC: 3.32; p < 0.001) with AAMR rising from 1.30 in 1999 to 2.70 in 2020, compared to urban areas (AAPC: 2.34%; p < 0.001), which rose from 1.04 to 1.85 over the same period. Geographically, the West showed the steepest long term increase (AAPC: 2.48) followed by the South (2.09). States with the highest AAMRs included the District of Columbia (2.36) and Mississippi (2.08); states with the lowest AAMRs included Hawaii (0.62) and Nevada (0.64).
PE and diabetes related mortality have increased significantly from 1999 to 2024, with disproportionate burden in males, rural and Southern populations. The results emphasize the need for improved cardiometabolic risk stratification and equitable access to healthcare in vulnerable populations.
The online version contains supplementary material available at https://doi.org/10.1007/s40200-026-02092-2.
Mortality data were extracted from the CDC WONDER Multiple Cause of Death database (1999-2024) using ICD-10 codes I26 for pulmonary embolism and E10-E14 for diabetes mellitus. Joinpoint regression was used to estimate APC (Annual Percent Change) and AAPC (Average Annual Percent Change). A p-value < 0.05 was considered statistically significant.
Between 1999 and 2024, the co-recorded pulmonary embolism and diabetes on death certificates showed 82,241 deaths, with the most deaths being recorded at the medical facility (61.29%). The overall AAMR rose significantly from 1.08 in 1999 to 1.88 in 2024, with an associated AAPC of 1.98 (95% CI: 1.10 to 2.87; p < 0.001). Widening gender gaps were observed, where males demonstrated higher mortality throughout the period. In 1999, men had an AAMR of 1.11, while women had an AAMR of 1.05. In 2024, it was 2.19 (AAPC: 2.44; 95% CI: 1.45 to 3.45; p < 0.001) in males and 1.63 (AAPC: 1.46; 95% CI: 0.18 to 2.76; p = 0.02) in females. Non-Hispanic Black individuals had the highest AAMR in 2024, at 4.01 (AAPC: 1.29; p = 0.06), followed by non-Hispanic White individuals (AAMR: 1.73), Hispanic or Latino individuals (AAMR: 1.59), and NH Other (AAMR: 0.98). Rural areas had steeper increases (AAPC: 3.32; p < 0.001) with AAMR rising from 1.30 in 1999 to 2.70 in 2020, compared to urban areas (AAPC: 2.34%; p < 0.001), which rose from 1.04 to 1.85 over the same period. Geographically, the West showed the steepest long term increase (AAPC: 2.48) followed by the South (2.09). States with the highest AAMRs included the District of Columbia (2.36) and Mississippi (2.08); states with the lowest AAMRs included Hawaii (0.62) and Nevada (0.64).
PE and diabetes related mortality have increased significantly from 1999 to 2024, with disproportionate burden in males, rural and Southern populations. The results emphasize the need for improved cardiometabolic risk stratification and equitable access to healthcare in vulnerable populations.
The online version contains supplementary material available at https://doi.org/10.1007/s40200-026-02092-2.
Authors
Mustafa Mustafa, Shahab Shahab, Naqvi Naqvi, Shaikh Shaikh, Masood Masood, Ahmed Ahmed, Shahzaib Shahzaib, Khalid Khalid
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