Prevalence and incidence of pulmonary embolism in China: a scoping review

Pulmonary embolism is associated with significant in-hospital mortality and represents a major challenge to health systems worldwide. In Europe and North America, the reported incidence of pulmonary embolism has been reported more extensively, but data from China remain insufficient, with substantial discrepancies compared with Western epidemiology. To synthesize contemporary evidence on the epidemiology and diagnostic evaluation of pulmonary embolism in China, with emphasis on incidence and prevalence by denominator, care setting, and geographic distribution. We conducted a Preferred Reporting Items for Systematic reviews and Meta-Analyses Extension for Scoping Reviews-compliant scoping review of studies published from database inception to 30 May 2025, across international and Chinese databases. Eligible studies reported pulmonary embolism epidemiology in Chinese healthcare settings and provided calculable denominators (population, hospital admissions, or emergency department visits). Outcomes were analyzed separately by denominator and synthesized descriptively. Of 5199 records identified, 29 studies met the inclusion criteria, and 12 could be assessed for incidence or prevalence. Population-based incidence ranged from 1.2 to 11.7 per 100 000 person-years (four studies; median = 6.25). Among hospital admissions, pulmonary embolism prevalence ranged from 0.1 to 5.9‰ (N = 11), with multicenter and nationwide datasets reporting more consistent estimates around 1.1-1.2‰ (N = 2). Among emergency department visits, reported prevalences were 0.04and 1.1‰ (N = 2). No study reported the prevalence of pulmonary embolism among patients presenting with clinical suspicion of pulmonary embolism; estimates were rather derived from cohorts evaluated with imaging. Most studies were retrospective and conducted in tertiary hospitals, with geographic clustering in South China and North China. Reported pulmonary embolism incidence and prevalence in China vary substantially across different clinical settings. Population-based incidence is lower than in Western cohorts, whereas among selected emergency department patients undergoing imaging or diagnostic work-up for pulmonary embolism, positivity rates are higher than those reported in Western countries. These findings may suggest under-testing among Chinese emergency department patients.