Between 1999 and 2020, pulmonary embolism mortality among U.S. adults with substance use disorders increased significantly, with an average annual percent change of +12.73% (95% CI: 10.47 to 17.34).
Observational (n=8,162)
Yes
Pulmonary embolism mortality among U.S. adults with substance use disorders has significantly increased from 1999 to 2020, highlighting the need for integrated cardiovascular and addiction care.
Effect estimate: AAPC +12.73% (95% CI 10.47 to 17.34)
p-value: p=<0.000001
Abstract Background Pulmonary embolism (PE) significantly increases cardiovascular mortality. Recent studies suggest that substance use disorders (SUDs) may influence PR outcomes; nonetheless, national-level assessments continue to be limited. This study examines temporal trends and demographic disparities in PE-related mortality among U.S. individuals with SUDs from 1999 to 2020. Methods We analyzed U.S. adults aged ≥45 years using CDC WONDER Multiple Cause of Death data (1999-2020). Deaths were included if pulmonary embolism (ICD-10 I26.x) was the underlying cause and substance use disorders (F10-F19) were contributing causes. Age-adjusted mortality rates (AAMRs) were calculated per 100,000 persons using the 2000 U.S. standard population. Trends were evaluated with Joinpoint regression to estimate annual and average annual percent change (AAPC), stratified by sex, race/ethnicity, region, and place of death. Results Between 1999 and 2020, a total of 8,162 deaths were reported in the United States where pulmonary embolism (PE) was the underlying cause and substance use disorders (SUDs) were contributing conditions. The total age-adjusted mortality rate (AAMR) grew sharply from 0.06 per 100,000 in 1999 to 0.47 in 2020, with an average AAMR of 0.29 per 100,000 for the research period. Joinpoint regression showed a strong climb from 1999 to 2004 (APC: +41.43%, 95% CI: 23.72 to 99.47; p 0.000001), and then a slower rise from 2004 to 2020 (APC: +5.02%, 95% CI: 3.79 to 6.36; p = 0.0004). The AAPC was +12.73% (95% CI: 10.47 to 17.34; p 0.000001), which shows an increasing trend. The average AAMR for men was 0.44 per 100,000, while it was 0.23 for women. African Americans had the highest average AAMR (0.43), followed by Caucasians (0.37), American Indians or Alaska Natives (0.29), and Asians or Pacific Islanders (0.02). Analysis by place of death revealed that most deaths occurred in medical facilities as inpatients (n = 4,334), followed by decedents’ homes (n = 1,594) and medical facilities outpatient or emergency departments (n = 1,293). Midwest reported the highest average AAMR at approximately 0.52 per 100,000, followed by the South (∼0.39), West (∼0.30), and the Northeast, which had the lowest average AAMR at approximately 0.32 per 100,000. Conclusion In the last 20 years, the number of persons with SUDs who die from PE has increased. This is especially true for people of all races and living in different places. These findings highlight the need for integrated cardiovascular and addiction care models, improved surveillance, and fair prevention measures within pulmonary and critical care systems. This abstract is funded by: NA
Balaji et al. (2026) conducted an observational in Pulmonary embolism and substance use disorders (n=8,162). Substance use disorders (exposure) was evaluated on Age-adjusted mortality rate (AAMR) per 100,000 persons (AAPC +12.73%, 95% CI 10.47 to 17.34, p=<0.000001). Between 1999 and 2020, pulmonary embolism mortality among U.S. adults with substance use disorders increased significantly, with an average annual percent change of +12.73% (95% CI: 10.47 to 17.34).