What is the clinical evidence from this study?

Study design: Observational. Population: Pulmonary embolism in patients with lung and bronchus malignancies (n=40198). Primary outcome: Age-adjusted mortality rates (AAMRs) per 100,000 population and annual percent change (APC) (APC 2.18%, 95% CI 0.65–5.59, p=0.004).

What does this research mean for the field?

Pulmonary embolism-related mortality among older adults with lung cancer has increased significantly from 1999 to 2020 and is projected to continue rising through 2030, with persistent demographic and geographic disparities. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

What question did this study set out to answer?

This research aims to quantify the mortality burden from pulmonary embolism in patients with lung and bronchus malignancies and forecast future trends.

May 30, 2026

Mortality from pulmonary embolism among patients with lung and bronchus malignancies: National trends and forecasting from CDC WONDER (1999–2030).

Key Result

Pulmonary embolism-related mortality among U.S. adults with lung cancer increased significantly from 2015 to 2020 (APC 2.18%; 95% CI 0.65-5.59; p=0.004) and is projected to continue rising.

Key Points

This research aims to quantify the mortality burden from pulmonary embolism in patients with lung and bronchus malignancies and forecast future trends.
Retrospective population-based analysis using the CDC WONDER database from 1999 to 2020.
Inclusion of U.S. adults aged ≥55 with pulmonary embolism as the underlying cause of death and lung malignancies as contributing causes.
Analysis of trends using Joinpoint regression and forecasting via autoregressive integrated moving average (ARIMA) models.
From 1999 to 2020, 40,198 deaths from PE were reported among lung cancer patients, with higher rates in males (54.6%) than females (45.3%, p < 0.05).
Age-adjusted mortality rates (AAMRs) increased significantly from 1999-2009 (APC = 3.65%; p = 0.010) and 2015-2020 (APC = 2.18%; p = 0.004).
Forecasting predicts an AAMR of 3.09 per 100,000 by 2030, indicating continual escalation in PE mortality.

Study Design

Type

Observational (n=40,198)

Structured PICO

Population

U.S. adults aged ≥55 years with pulmonary embolism listed as the underlying cause of death and malignant neoplasms of the lung and bronchus listed as contributing causes (n=40,198 deaths).

Outcome

Age-adjusted mortality rates (AAMRs) per 100,000 population and temporal trends (Annual Percent Change)hard clinical

Pulmonary embolism-related mortality among older adults with lung cancer has increased significantly over the past two decades in the US and is projected to continue rising.

Main Result

Effect estimate: APC 2.18% (95% CI 0.65–5.59)

p-value: p=0.004

Abstract

e20116 Background: Pulmonary embolism (PE) represents a major cause of preventable mortality in patients with lung cancer due to hypercoagulability, treatment-related risk, and prolonged immobility. Contemporary national trends quantifying the population-level burden of PE-related mortality in this high-risk group remain limited. We evaluated long-term mortality patterns and projected future burden of PE among U.S. adults with lung and bronchus malignancies. Methods: A retrospective population-based analysis was done using the CDC WONDER Multiple Cause-of-Death database (1999–2020). Adults aged ≥55 years with PE (ICD-10 I26) listed as the underlying cause of death and malignant neoplasms of the lung and bronchus (ICD-10 C34) listed as contributing causes were included. Age-adjusted mortality rates (AAMRs) per 100,000 population were calculated and stratified by sex, race/ethnicity, geographic region, and urban–rural classification. Temporal trends were assessed using Joinpoint regression to estimate annual percent change (APC). Time-series forecasting was performed using autoregressive integrated moving average (ARIMA) models with Box-Cox transformation and stationarity testing (ADF/KPSS), with residual diagnostics for model validation. Results: From 1999-2020, 40,198 deaths were attributed to PE among patients with lung and bronchus malignancies. Mortality was higher among males compared with females (54.6% vs 45.3%, p < 0.05) and among non-Hispanic White individuals (85.2%). National AAMRs increased significantly during 1999–2009 (APC = 3.65%; 95% CI: 2.85–4.71; p = 0.010) and again during 2015–2020 (APC = 2.18%; 95% CI: 0.65–5.59; p = 0.004). Forecast modeling projected continued escalation in PE mortality, with AAMR reaching 3.09 per 100,000 by 2030 (95% CI: 2.61–3.50), supported by favorable model performance (RMSE = 0.070; Ljung-Box p = 0.296). Regional heterogeneity was observed, with the Northeast demonstrating early acceleration (APC = 5.81%, 1999–2008; p < 0.001) and the Midwest exhibiting sustained increases (APC = 6.98%, 2008–2020; p < 0.001). Both large central metropolitan areas (APC = 4.46%, 1999–2008; p < 0.001) and rural non-core counties (APC = 2.50%, 1999–2020; p < 0.001) demonstrated persistent upward trends. Wisconsin (AAMR = 2.6) and Alaska (2.5) exceeded the national mean mortality rate (2.03 per 100,000). Conclusions: PE-related mortality among older adults with lung cancer has increased significantly over the past two decades and is projected to continue rising. Persistent demographic and geographic disparities highlight critical gaps in thromboprophylaxis utilization, early PE detection, and equitable access to cancer-associated thrombosis care. Findings underscore the urgent need for risk-stratified preventive strategies and targeted intervention frameworks in high-risk populations.

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