Temporal and regional mortality trends due to pulmonary embolism in female patients with genital cancers in the United States from 1999 to 2020.

Abstract

5617 Background: The involvement of pulmonary vessels by tumor emboli has been described from different primary sites of malignancy. Pulmonary embolism (PE) is a severe and potentially fatal complication in patients with female genital cancers, including ovarian, cervical, uterine, and vulvar malignancies. These cancers, along with associated treatments such as major abdominal surgery, chemotherapy, and hormone therapy, significantly increase the risk of venous thromboembolism (VTE), including PE. While previous studies detail the advancements in cancer detection and treatment, temporal and regional trends of PE-related mortality among female genital cancer patients remain poorly characterized. Methods: This retrospective study analyzes national mortality data from the CDC WONDER database to assess mortality trends from 1999 to 2020 across different demographic subgroups in the United States. Patients with a known history of genital cancer were identified and PE related mortality data was retrieved. Age-adjusted mortality rates (AAMRs) per 100,000 individuals were calculated further stratified based on sex, age (15-64 years and >64 years), race and census region. Rstudio was used to perform t-test and Mann Kendall test. Results: From 1999 to 2020, a total of 13,692 deaths were reported in female genital cancer associated pulmonary embolism in the US (AAPC: 0.421 (95% CI: 0.414-0.428)). The AAMR has risen from 0.363 in 1999 to 0.590 in 2020, indicating a worsening trend over the study period (τ: 0.680, p<0.001). AAMR varied greatly by region, with the Northeast having the highest AAMR (9.928). This was followed by the West (0.488), Midwest (0.43) and South (0.366). Black females had consistently higher AAMR than white females, with rates of 0.763 vs. 0.329 in 1999 and 0.976 vs. 0.523 in 2020, respectively. Females older than 65 years demonstrated a much higher total AAMR (1.506) compared to females between the ages of 15 and 65 (0.212) (p<0.001). Within the age group of 15-25 years, black females had higher AAMRs compared to white female (p<0.001). Black females of the age group >65 years demonstrated much higher mortality (total AAMR: 2.745) than white females of the same age group (1.419), and the highest AAMR overall (P<0.001). Conclusions: The analysis of AAMR for female genital cancer associated pulmonary embolism highlights a concerning disparity in this dangerous cancer related complication, particularly after 2015. This underscores the need for greater attention to be directed towards reproductive health and cancer related complications faced by black women and to address systematic inequalities in intervention and healthcare access. This can improve early detection and timely interventions in order to reduce mortality and improve outcomes for these patients.