An analysis of vital registration data from the WHO Mortality Database (2000-2015).

Key Takeaway

  • This comprehensive analysis of data from the World Health Organization (WHO)’s Mortality Database shows that age-standardised pulmonary embolism (PE)-related mortality has been continuously declining in both women and men across all European subregions since 2000, possibly reflecting advances in prophylaxis and treatment.
  • Despite this trend, PE remains an important contributor to total mortality, particularly among women aged 15-55 years.

Why This Matters

  • Findings contribute to a significant correction of past mortality estimates and strengthen the basis for cause of death estimation of venous thromboembolic disorders.
  • PE still represents a global problem. Therefore, continuing efforts are warranted to improve awareness and implement effective preventive and risk-adapted therapeutic measures.

Study Design

  • Disease burden and time trends in PE-related mortality were assessed in the WHO European Region, covering a total population of >650 million by analysing the vital registration data from the WHO Mortality Database (2000-2015).
  • Deaths were PE related if International Classification of Disease-10 code for acute PE (I26) or any code for deep or superficial vein thrombosis was listed as the primary cause of death.
  • Proportionate mortality and time trends in age-standardised mortality were calculated using locally estimated scatterplot smoothing weighted by the size of the Member State population.
  • Funding: German Federal Ministry of Education and Research.

Key Results

Between 2013 and 2015:

  • On an average, 38,929 PE-related deaths occurred annually in the 41 member states with a population of 650,950,921 individuals.
  • The age-standardised annual PE-related mortality rate was 6.8 (95% CI, 6.5-6.9) deaths per 100,000 population.
  • PE was the primary cause of death in 7.5 (95% CI, 7.4-7.6) and 5.4 (95% CI, 5.4-5.5) cases per 1000 deaths in women and men (proportionate mortality), respectively.
  • This difference was most prominent between 15 and 55 years of age.
  • Among individuals aged 15-55 years, PE-related deaths accounted for 8-13 and 2-7 cases per 1000 deaths in women and men, respectively.
  • Overall sex difference and age-specific peaks were less evident in Eastern Europe.
  • PE-related mortality increased with age, with a seemingly exponential distribution.

From 2000 to 2015:

  • The age-standardised annual PE-related mortality rate decreased from 12.8 (95% CI, 11.4-14.2) to 6.5 (95% CI, 5.3-7.7) deaths per 100,000 population.
  • Joinpoint regression analysis showed a linear reduction in age-standardised PE-related mortality (annual change, –0.48 [95% CI, –0.52 to –0.43] deaths per 100,000 population), consistent between sexes.
  • Time trend analysis by subregion revealed that the reduction was consistent across all subregions, except for Central Asia, which had an increasing trend.


  • The possibility of underestimation of PE-related mortality cannot be excluded.
  • The number of diagnosed cases, necessary for estimating case fatality trends, was not provided in the database.
  • Relevant geographical differences may exist in terms of quality of care, diagnostic algorithms, management and quality and completeness of data submitted to WHO.
    1. Barco S, Mahmoudpour SH, Valerio L, Klok FA, Münzel T, Middeldorp S, Ageno W, Cohen AT, Hunt BJ, Konstantinides SV. Trends in mortality related to pulmonary embolism in the European Region, 2000-15: analysis of vital registration data from the WHO Mortality Database. Lancet Respir Med. 2019 Oct 11 [Epub ahead of print]. doi: 10.1016/S2213-2600(19)30354-6. PMID: 31615719

MAT-BH-2200561/V1/June 2022