Temporal Trends and Demographic Disparities in Mortality Involving Pulmonary Embolism and Diabetes Mellitus Among U.S. Adults Aged ≥25 Years, 1999–2024: A CDC WONDER Analysis
This CDC WONDER analysis reveals that from 1999 to 2024, mortality involving both pulmonary embolism and diabetes mellitus among U.S. adults aged 25 and older increased overall by nearly 74%, with significant and widening disparities observed across sex, race, age, region, and urbanization levels.
Original paper licensed under CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). This is an AI-generated explanation of the paper below. It is not written or endorsed by the authors. For technical accuracy, refer to the original paper. Read full disclaimer
Every year, millions of people in the United States face a sudden and dangerous blockage in the blood vessels of their lungs, a condition known as pulmonary embolism. This happens when a blood clot, usually formed in the legs, travels upward and lodges in the lungs, cutting off oxygen and straining the heart. At the same time, diabetes, a chronic condition where the body struggles to manage sugar levels, affects a vast number of Americans. While doctors have long known that diabetes can make the blood more prone to clotting and that it complicates recovery from heart and lung issues, the full picture of how these two conditions interact over time has remained unclear. Specifically, there was no comprehensive look at how often people died when both conditions were listed on their death certificates, nor was there a clear map of who was most at risk across different ages, races, and regions of the country. Understanding this intersection is vital because it reveals where the most vulnerable people are hiding in plain sight and how their risks have shifted over the last quarter-century.
To fill this gap, a team of researchers turned to a massive digital archive of death records maintained by the Centers for Disease Control and Prevention, known as CDC WONDER. They examined every death certificate from 1999 to 2024 for adults aged 25 and older that listed both pulmonary embolism and diabetes as contributing factors. By analyzing over 82,000 such deaths, they were able to track the changing landscape of this specific health crisis. The data revealed a story of rising danger that did not move in a straight line. From the start of the study in 1999 until 2018, the rate of deaths involving both conditions crept up slowly. Then, between 2018 and 2021, the numbers surged dramatically, climbing at a pace far faster than before. However, the trend did not continue upward forever; from 2021 through 2024, the rate began to fall significantly, suggesting a shift in the factors driving these deaths.
The study painted a detailed portrait of who is most affected by this combination of illnesses. Men faced a higher risk of death than women, and their death rates rose more quickly over the decades. Race played a stark role as well; Black or African American individuals consistently experienced the highest death rates throughout the entire period, far exceeding those of White or Hispanic populations. Age was another critical factor, with the burden falling heaviest on those aged 65 and older, who carried the greatest absolute number of deaths. Geographically, the South emerged as the region with the highest death rates by the end of the study period, while the West saw the fastest overall increase in risk. Even within communities, location mattered; people living in non-metropolitan, rural areas faced higher death rates than those in cities, at least through the year 2020.
The sharp spike in deaths between 2018 and 2021 coincided with the global pandemic, a time when hospitals were overwhelmed and many people with chronic conditions faced disrupted care. The researchers noted that the virus itself is known to increase the risk of blood clots, and the stress of the pandemic likely exacerbated the risks for those already managing diabetes. While the reasons for the subsequent decline after 2021 are not fully detailed in the data, the drop suggests that as the immediate crisis of the pandemic eased and medical care returned to more stable patterns, the pressure on this vulnerable group may have lessened. The study did not determine exactly why the rates changed, but it provided a clear, data-driven map of where the problem is most severe.
Ultimately, this analysis serves as a warning and a guide. It shows that while the overall number of deaths involving pulmonary embolism and diabetes has risen over the last 25 years, the risk is not shared equally. The data highlights deep disparities based on gender, race, age, and geography, pointing to specific groups that need more attention and better access to care. The researchers conclude that to reduce these deaths, the medical community and public health officials must focus on targeted prevention, ensure that people with diabetes receive timely recognition of clotting risks, and work to eliminate the barriers that prevent equitable healthcare for all. The numbers tell a story of a growing challenge, but they also point the way toward where solutions are most urgently needed.
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