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CC BY 4.0 · Thromb Haemost
DOI: 10.1055/a-2668-5296
Coagulation and Fibrinolysis

Time Trends in Cause-specific Mortality in Patients with Pulmonary Embolism Aged 50 Years and Older

Katarina Glise Sandblad 
1   Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
2   Department of Medicine, Geriatrics and Emergency Medicine, Region Västra Götaland, Sahlgrenska University Hospital/Östra, Gothenburg, Sweden
,
Kristina Svennerholm
3   Department of Anaesthesiology and Intensive Care, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
4   Department of Anaesthesiology and Intensive Care, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
,
Jacob Philipson
1   Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
2   Department of Medicine, Geriatrics and Emergency Medicine, Region Västra Götaland, Sahlgrenska University Hospital/Östra, Gothenburg, Sweden
,
Maria Roupe
1   Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
5   Department of Medicine, Region Västra Götaland, Sahlgrenska University Hospital/Mölndal, Gothenburg, Sweden
,
Aldina Pivodic
6   APNC Sweden, Gothenburg, Sweden
,
Andrea Dahl Sturedahl
6   APNC Sweden, Gothenburg, Sweden
,
Carl Johan Svensson
3   Department of Anaesthesiology and Intensive Care, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
4   Department of Anaesthesiology and Intensive Care, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
,
Sam Schulman 
7   Department of Medicine and Thrombosis and Atherosclerosis Research Institute, McMaster University, Hamilton, Ontario, Canada
,
Mazdak Tavoly
8   Department of Medicine, Geriatrics and Emergency Medicine, Region Västra Götaland, Sahlgrenska University Hospital/Sahlgrenska, Gothenburg, Sweden
9   Department of Research, Østfold Hospital, Sarpsborg, Norway
› Author Affiliations
Funding The Swedish Heart and Lung Foundation 20220216 and 20240482. The Swedish state under the agreement between the Swedish government and the county councils ALFVGR-1006039. The Gothenburg Society of Medicine GLS-999259. Elsa and Gustav Lindh's Foundation. The funding sources were not involved in the study design, in the collection, analysis, or interpretation of data, in the writing of the report, or in the decision to submit the paper for publication.
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Abstract

Background

Patients with pulmonary embolism (PE) have high mortality rates. However, data on cause-specific mortality trends in this population are limited.

Aims

To study time trends in cause-specific mortality among PE patients aged ≥50 years, analyzed across three time periods: 2006–2011, 2012–2017, and 2018–2023. The secondary aims included examining mortality trends in matched controls and subgroups of PE patients.

Methods

This nationwide Swedish register study included patients with a first-time PE and matched controls. We assessed 30-day and 31- to 365-day cause-specific mortality and employed age- and sex-adjusted Poisson regression for the relative risk (RR) for annual mortality trends.

Results

The study comprised 115,476 patients, with cancer as the leading cause of 30-day mortality, stable at 4.7% from 2006–2011 to 2018–2023 (RR 1.00; 95% confidence interval [CI]: 0.99–1.01). Mortality from fatal venous thromboembolism (VTE) decreased from 2.7 to 1.3% (RR 0.94; 95% CI: 0.93–0.95), and cardiovascular disease from 2.3 to 1.1% (RR 0.94; 95% CI: 0.93–0.94). The 31- to 365-day mortality from cancer was stable at 11.8% in 2006–2011 and 11.4% in 2018–2022 (RR 1.00; 95% CI: 0.99–1.00), while mortality due to cardiovascular disease decreased from 4.1 to 2.3% (RR 0.96; CI: 0.95–0.96), and fatal VTE from 0.8 to 0.5% (RR 0.95; 95%: 0.93–0.96). Subgroup analysis showed a decrease in cancer-related mortality among PE patients with known cancer, while it increased in those without known cancer.

Conclusion

Cancer was the leading cause of death in PE patients aged ≥50 years, with stable rates over time due to contrasting trends in patients with and without known cancer. Fatal VTE comprised a minor percentage of overall mortality in recent years.

Keywords

pulmonary embolism - mortality - trend - neoplasm

Authors' Contribution

K.G.S. planned the study; A.D.S. and A.P. performed statistical analyses; K.G.S. wrote the first draft of the manuscript; K.G.S., K.S., J.P., M.R., S.S., M.T., and C.J.S. provided clinical input at all stages of the project. All authors, particularly M.T. and K.G.S., made important contributions to the design of this study. All authors, particularly M.T. and K.G.S., reviewed and edited the manuscript. All authors were involved in interpreting the data and approved the final draft.


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Publication History

Received: 26 March 2025

Accepted: 28 July 2025

Accepted Manuscript online:
29 July 2025

Article published online:
08 August 2025

© 2025. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

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