Trends and Disparities in Mortality due to Pulmonary Embolism Among Adults With Atrial Fibrillation From 1999 to 2020: Insights From the CDC WONDER Database

ABSTRACT Background Pulmonary embolism (PE) remains a major cause of cardiovascular mortality, and atrial fibrillation (AF) significantly worsens its outcomes. However, long‐term trends and disparities in PE mortality among patients with AF remain poorly characterized. Methods Using the CDC WONDER database (1999–2020), we identified adults with PE as the underlying cause of death and AF as a contributing cause using ICD‐10 codes I26 and I48. Age‐adjusted mortality rates (AAMRs) and annual percentage changes (APCs) were calculated via Joinpoint regression. Subgroup analyses were done based on the pre‐, during, and post‐COVID‐19 pandemic era. Results A total of 5499 deaths were recorded with PE and coexisting AF. Overall mortality remained stable from 1999 to 2009 (APC: –0.27; 95% CI: −2.12 to 1.60), then rose sharply from 2009 to 2020 (APC: 3.68; 95% CI: 2.29–5.10). Males had higher mortality (AAMR: 0.077) than females (0.065), with faster increases over time. Non‐metropolitan areas showed greater mortality (AAMR: 0.082) than metropolitan areas (0.063), with steeper APCs (2.73% vs. 2.00%). Regionally, the Midwest (AAMR: 0.077) and South (0.073) bore the highest burden. States with the highest mortality included Vermont and Maryland. Most deaths occurred in inpatient settings (55.7%), followed by nursing homes (15.8%) and decedents' homes (14.5%). Notably, states with the lowest AAMRs were New York, Louisiana, and Florida. Conclusions Mortality due to PE with AF as a contributor has increased significantly since 2009, with marked sex, regional, and urban–rural disparities. These findings underscore the growing public health burden and the need for targeted regional responses.