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Incidence, risk factors, and mortality of pulmonary embolism in the Netherlands (2015-22): sex differences and shifts during the coronavirus disease 2019 pandemic

Eur Heart J. 2025 Apr 2:ehaf211. doi: 10.1093/eurheartj/ehaf211. Online ahead of print.

ABSTRACT

BACKGROUND AND AIMS: Epidemiology of pulmonary embolism (PE) may have shifted since the coronavirus disease 2019 (COVID-19) pandemic. This study aimed to describe temporal trends in PE epidemiology in the Netherlands since 2015.

METHODS: Using nationwide data from Statistics Netherlands, all Dutch inhabitants (>16 million) without a history of PE were dynamically identified on 1 January of each year to assemble eight cohorts of PE-free Dutch inhabitants in 2015-22. They were individually followed until the end of that respective year to determine 1-year risk of PE (identified by hospital diagnoses/primary cause of death) and establish relevant risk factors. The PE cases were subsequently studied to determine 1-year all-cause mortality following PE. Multivariable logistic regression with cluster-robust standard errors and robust Poisson regression were respectively employed to evaluate relative differences in PE incidence and mortality between years.

RESULTS: Pulmonary embolism incidence in the Dutch population decreased from 2015 to 2019 but markedly increased by 23% (95% confidence interval 20%-26%), 52% (48%-56%), and 7% (4%-9%) in 2020-22 (vs. 2019), respectively. Most traditional PE risk factors remained associated with PE in 2020-22 but generally with a weaker association. Pulmonary embolism mortality was stable until 2019 but then increased by 10% (6%-14%) in 2020 and 9% (6%-13%) in 2021, while the increase [2% (-1% to 6%)] was insignificant in 2022. The above-mentioned changes since 2020 were generally greater in males than females.

CONCLUSIONS: The seemingly favourable pre-pandemic temporal trends in PE epidemiology in the Netherlands reversed during the COVID-19 pandemic but appear to revert to pre-pandemic levels after 2022.

PMID:40172984 | DOI:10.1093/eurheartj/ehaf211

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