Trends in mortality from deep vein thrombosis and pulmonary embolism as multiple causes of death in u.S. adults aged ≥65 years (1999–2023): A CDC wonder analysis

Abstract

Abstract Background: Pulmonary embolism (PE), often arising as a complication of deep vein thrombosis (DVT) is a leading cause of thromboembolic mortality, primarily through mechanisms such as pulmonary infarction, tissue hypoxia, sudden cardiac death due to right ventricular failure, or arrhythmias. Despite clinical advances, long-term population-level mortality trends from these conditions remain insufficiently characterized. Methods: We analysed mortality data from the CDC WONDER database (1999–2023), identifying deaths with PE (I26.0) and DVT (I80.0–I80.9) using ICD-10 codes. Age-adjusted mortality rates (AAMRs) per 100,000 were calculated for U.S. adults aged ≥65 years using the 2000 U.S. standard population. Data were stratified by sex, race/ethnicity, region, urbanization and state. Joinpoint regression estimated average annual percent change (AAPC) with 95% confidence intervals (CI), using p<0.05 as statistically significant. Results: From 1999 to 2023, 76,055 deaths among adults aged ≥65 were attributed to DVT and PE. The AAMR rose from 5.59 to 6.94 per 100,000 (AAPC: 0.63; 95% CI: -0.85 to 2.13). AAMR among the men increased significantly from 5.62 to 7.12 (AAPC: 0.63; 95% CI: -0.85 to 2.13). Females saw a consistent increase in mortality from 5.48 to 6.71 (AAPC: 0.74; 95% CI: -0.40 to 1.89). Among Non-Hispanic (NH) Black AAMR rose from 9.04 to 10.86 (AAPC:0.80 ; 95% CI: -1.22 to 2.87), whileAAMR in the Hispanics declined from 5.26 to 4.84 (AAPC: -1.55; 95% CI: -2.29 to -0.81). Geographically, the South showed the highest overall AAPC (1.20; 95% CI: -0.30 to 2.73), followed by the West (0.69),the Midwest(0.36) and the Northeast(-0.15).Medium micropolitan areas showed the fastest growth (AAPC: 1.90; 95% CI: 0.62–3.19; p=0.003), with an increase in mortality rates from 5.15 to 8.9 while among the non-metropolitan areas, micropolitan areas had the highest AAPC of 2.74 and a steep increase in the AAMR from 4.56 to 9.76. States in the 90th percentile included the District of Columbia (14.01), Vermont (9.32), Tennessee (9.25), Ohio (9.21), and Colorado (9.07). Conclusions: Mortality from DVT and PE among older U.S. adults has modestly increased over the past two decades, with pronounced disparities among males, NH Blacks, West as well as both parts of rural and urban areas. These findings underscore the need for targeted prevention strategies and health equity interventions for high-risk populations.