Mortality Trends in the United States for Adults with Concurrent Cerebrovascular Disease and Pulmonary Embolism

Abstract

Background: Pulmonary embolism (PE) and cerebrovascular disease are major global causes of mortality and may share common risk factors. This study analyzed U.S. all-cause mortality trends where PE and cerebrovascular diseases were recorded on the death certificate from 1999 to 2023. Methods: Using national all-cause mortality data for adults aged over 25 years whose death certificates recorded both PE (ICD-10 I26) and cerebrovascular diseases (ICD-10 I60–I69), we calculated age-adjusted mortality rates (AAMRs), standardized to the 2000 U.S. population. Joinpoint regression was applied to identify significant trends and compute annual and average annual percent changes (APC and AAPC). Subgroup analyses were performed by sex, age, race, region, and urbanization level. Results: Between 1999 and 2023, 59,075 U.S. deaths involved both pulmonary embolism and cerebrovascular disease, with 4,274 recorded in 2023. Age-adjusted mortality increased from 1.00 to 1.55 per 100,000 (AAPC: 1.93%), accelerating sharply during 2018–2021. Higher AAMR was observed in males, adults over 85 years, Non-Hispanic Black individuals, residents of the South, and non-metropolitan areas. Substantial geographic heterogeneity existed, with states such as Minnesota, Washington, Massachusetts, and Florida showing significant long-term upward trends. Conclusion: The accelerating mortality and pronounced disparities across demographic and geographic groups highlight the need for more precise public health strategies. Mitigating this burden requires targeted interventions for high-risk populations, equity-focused policies, improved healthcare access, geriatric-sensitive care, and strengthened infrastructure in vulnerable regions.