Trends in mortality due to lymphoma and pulmonary embolism in the United States, 1999–2020: A CDC wonder database population analysis

Abstract

Abstract Introduction: Lymphoma is associated with many serious complications one which includes pulmonary embolism (PE). If these occur together, they can significantly impact patient outcomes. While cancer-associated thrombosis is well recognized, there is limited data on how deaths from both lymphoma and PE have changed over time in the U.S. This study looks at national trends and differences across demographic groups to better understand who might be at higher risk. Methods: We used data from the CDC WONDER database (1999–2020), identifying deaths that listed both lymphoma (ICD-10: C81–C85) and pulmonary embolism (ICD-10: I26) as causes. Age-adjusted mortality rates (AAMRs) were calculated per 100,000 people using the 2000 U.S. standard population. We applied Joinpoint regression to assess trends and calculate annual percent changes (APCs) across different age, sex, race, geographic, and urbanization categories. Results: A total of 7,718 deaths were attributed to both lymphoma and PE during the study period. The AAMR increased nationally from 0.15 in 1999 to 0.22 in 2020. Joinpoint analysis showed a significant decline from 1999 to 2017 (APC: −1.01%), followed by a rise through 2020 (APC: +10.78%, p = 0.12). For males, AAMR rose from 0.17 to 0.23, with a drop until 2012 (APC: −2.14%) and then a significant increase (APC: +2.78%). Females showed an AAMR increase from 0.12 to 0.21, with no significant trend (APC: −0.24%). Among racial groups, White individuals saw an increase in AAMR from 0.16 to 0.24, with an initial decline until 2017 (APC: −1.48%) and a later rise (APC: +12.86%). Black individuals had a smaller AAMR increase from 0.10 to 0.16, with a stable overall trend (APC: −0.36%). Crude mortality rates by age group showed the highest rates in those ≥85 years, increasing from 0.51 to 0.67 per 100,000 (APC: +1.36%). Patients aged 65–74 experienced a decline until 2016 (APC: −1.54%), then an increase (APC: +7.62%). Regionally, Northeast AAMR rose from 0.16 to 0.23, while the Midwest declined through 2016 (APC: −1.43%) and rose thereafter (APC: +8.91%). Urbanization analysis revealed a steady decline in large fringe metros (APC: −1.74%) and a shift toward rising mortality in medium metro areas after 2012 (APC: +3.54%). Conclusion: Mortality due to PE and Lymphoma have started to plateau or even rise in recent years after years of decline. We saw this trend across several groups that included older adults, white population and some geographic regions. These findings are indicative that we need improved screening and preventative care for lymphoma patients for timely diagnosis of PE to prevent mortality.