The Center for Thrombosis and Hemostasis (CTH) at the University Medical Center Mainz has published study results in Lancet Respiratory Medicine: a decreasing death rate due to pulmonary embolism was observed in North America for the period 2000 to 2017. However, the study “Age-sex specific pulmonary embolism-related mortality in the USA and Canada, 2000-18: an analysis of the WHO Mortality Database and of the CDC Multiple Cause of Death database” also showed that for several years now, more younger and middle-aged people in the USA have been dying from thrombosis and its complications.
A large international study of the importance of acute pulmonary embolism as a global cause of death has produced unexpected results on mortality from thrombosis and pulmonary embolism. The research team, led by Stefano Barco, M.D., and Prof. Stavros Konstantinides, M.D., of the Center for Thrombosis and Hemostasis (CTH) at the University Medical Center Mainz, Germany, found a declining death rate due to pulmonary embolism in North America from 2000 to 2017. At the same time, however, the study also showed, to the astonishment of the scientists, that for some years now more young and middle-aged people in the USA have been dying of thromboses and their complications. The study results were published today in Lancet Respiratory Medicine, the world’s most prestigious journal of pulmonary disease and critical care medicine.
The authors of the international clinical trial, senior European, U.S., and Canadian experts, analyzed World Health Organization (WHO) data for the entire populations of Canada and the United States from 2000-2017 regarding thrombosis and pulmonary embolism as causes of death. The study shows that overall, fewer and fewer people are dying from pulmonary embolism.
However, when they looked at the thrombosis data in more detail, the scientists came to an unexpected conclusion: in the USA, more people of younger and middle age have been dying of thrombosis and its complications again for several years. Among the prosperous industrialized nations of the 21st century, this negative trend is a novelty. It is all the more worrying because it is accompanied by a decline in life expectancy in this country.
For decades, the world was used to success stories in the fight against cardiovascular disease. This included pulmonary embolism, one of the leading causes of cardiovascular mortality worldwide. Already a few months ago, another study by the team of authors led by Dr. Barco was able to show that the mortality from pulmonary embolism in European countries including Germany almost halved between 2000 and 2015. Until now, experts interpreted this as an indication of the ever-improving diagnostics and therapy of this disease. How can the current results of the study be explained now? And what do they mean for patients and healthcare systems, including in Germany and Europe?
“Several factors may contribute to the recent unfavorable trend in the U.S.,” explains Dr. Barco, who led the study as principal investigator. “Social inequalities combined with financial hardship can result in an ever-increasing proportion of the population not having access to healthcare. In parallel, serious chronic diseases such as diabetes, obesity and lung disease, which in turn increase the risk of thrombosis, are increasingly common.”
Professor Konstantinides, Head of the Multicenter Clinical Trials Professorship and Medical Director of the CTH, adds: “Once again, it becomes clear that optimal medical care requires much more than state-of-the-art examination and treatment methods. These are of little use at the population level if they are not affordable or come too late due to a lack of prevention and an unhealthy lifestyle.”
“Epidemiological studies do not use experimental procedures and therefore cannot provide direct evidence of the causes of their findings,” Dr. Barco explains. “However, given the large numbers of patients and highly complex statistics, their observations are reliable and robust. Therefore, they can help identify threats to the population and thus improve public health strategies.”
Original publication: Age-sex specific pulmonary embolism-related mortality in the USA and Canada, 2000-18: an analysis of the WHO Mortality Database and of the CDC Multiple Cause of Death database; Stefano Barco MD, Luca Valerio MD, Prof. Walter Ageno MD, Prof. Alexander T. Cohen MD, Prof. Samuel Z. Goldhaber MD, Prof. Beverley J. Hunt MD, Prof. Alfonso Iorio MD, David Jimenez MD, Frederikus A. Klok MD, Prof. Nils Kucher MD, Seyed Hamidreza Mahmoudpour PhD, Prof. Saskia Middeldorp MD, Prof. Thomas Münzel MD, Vicky Tagalakis MD, Aaron M. Wendelboe PhD, Prof. Stavros V. Konstantinides MD
