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March 1, 2026Frontiers in NeurologyOpen Access

U.S. mortality from concurrent pulmonary embolism and cerebrovascular disease rises ~55% from 1999 to 2023.

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Why the study?

Pulmonary embolism and cerebrovascular disease are major global causes of mortality that may share common risk factors, but long-term concurrent mortality trends were uncharacterized.

Population

59,075 U.S. decedents aged over 25 years with both PE and cerebrovascular diseases recorded on death certificates

Comparison

Trends across sex, age, race, region, and urbanization level from 1999 to 2023

Design

National death certificate-based observational trend study using Joinpoint regression

Key result

Age-adjusted mortality rate for combined pulmonary embolism and cerebrovascular disease in U.S. adults increased by 55% from 1.00 to 1.55 per 100,000 with an average annual percent increase of 1.93% over 1999–2023.

Authors

TLTian LvYXYujun XiongYCY. Chen

Discussion

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Overview

Warrants heightened clinical vigilance for concurrent pulmonary embolism and cerebrovascular disease; extends evidence of a growing burden accelerated during COVID-19.

Key Points

  • The study aims to analyze mortality trends associated with pulmonary embolism and cerebrovascular disease in the U.S. population from 1999 to 2023.
  • Analyzed national mortality data for adults over 25 with PE and cerebrovascular diseases on death certificates.
  • Calculated age-adjusted mortality rates (AAMRs) standardized to the 2000 U.S. population.
  • Utilized joinpoint regression to identify significant mortality trends and percent changes.
  • Conducted subgroup analyses based on sex, age, race, region, and urbanization.
  • 59,075 U.S. deaths recorded involved both conditions from 1999 to 2023, with 4,274 in 2023.
  • Age-adjusted mortality increased from 1.00 to 1.55 per 100,000, with an average annual percent change of 1.93%.
  • Sharp increases in mortality were noted between 2018 and 2021.
  • Higher mortality rates found among males, individuals over 85, Non-Hispanic Black individuals, and those in rural areas.
  • Significant geographic disparities revealed, with some states exhibiting long-term upward trends.

Study Design

Type

Observational (n=59,075)

Multicenter

Yes

Structured PICO

P
Population
59,075 U.S. adults aged over 25 years whose death certificates recorded both pulmonary embolism (ICD-10 I26) and cerebrovascular diseases (ICD-10 I60–I69) between 1999 and 2023.
O
Outcome
Age-adjusted mortality rates (AAMRs) and trends (annual and average annual percent changes) of concurrent pulmonary embolism and cerebrovascular disease deaths from 1999 to 2023hard clinical

Main Result

Effect estimate: AAPC 1.93% (95% CI 0.91 to 2.97%) increase in AAMR from 1999 to 2023 (95% CI 0.91 to 2.97%)

Absolute Event Rate: 1.55% vs 1%

p-value: p=<0.05

Age-adjusted mortality for concurrent pulmonary embolism and cerebrovascular disease in the U.S. increased significantly from 1999 to 2023, highlighting a growing public health burden that accelerated during the COVID-19 pandemic.

Limitations

  • Data based on death certificate coding and may not reflect acute events or direct cause of death.
  • Absence of detailed clinical variables such as diagnostic methods, treatment, and timing of events.
  • Aggregated data preclude individual-level causal inference or temporal sequencing.
  • Unable to distinguish acute, chronic, or historical cerebrovascular disease cases.
  • Potential confounding by COVID-19 pandemic and changes in death certification practices.
  • No formal adjustment for multiple comparisons in subgroup analyses.
  • Aggregated rather than individual-level records prevent enumeration of stepwise exclusions or missing demographic variables
  • Cannot infer causal relationships or temporal sequencing between events from death certificates
  • State-years with suppressed or sparse data were omitted entirely
  • No formal adjustment for multiple comparisons was applied

Cite This Study

Lv et al. (2026) conducted an observational in U.S. adults aged over 25 years with death certificates recording concurrent pulmonary embolism and cerebrovascular diseases (n=59,075). Age-adjusted mortality rate for combined pulmonary embolism and cerebrovascular disease in U.S. adults increased by 55% from 1.00 to 1.55 per 100,000 with an average annual percent increase of 1.93% over 1999–2023.

synapsesocial.com/papers/69a3d747ec16d51705d2db44https://doi.org/10.3389/fneur.2026.1738297
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