Trends and racial disparities in pulmonary embolism–related mortality among older adults with neoplasms: A population-based retrospective study in the United States from 1999-2020.

11157 Background: Pulmonary embolism (PE) remains a major cause of preventable mortality, particularly among older adults with cancer who face heightened thrombotic risk. Understanding temporal trends in PE-related deaths is essential for guiding prevention and early detection. This study evaluates national patterns and racial disparities in PE-related mortality among older adults with neoplasms. Methods: We performed a retrospective cross-sectional analysis of the national death certificate data from the CDC's WONDER database. We included persons ≥65 years of age with neoplasms (ICD-10 code C00-D48) as the underlying cause of death and PE (ICD-10 code I26) as a contributing cause of death. The exposure variable was the year of death, and the outcome was PE-related age-adjusted mortality rate (AAMR) stratified by sex, race, rural-urban status, and census region. We calculated the PE-related AAMR in neoplasm per 100,000 population. Trends were evaluated with Joinpoint regression and expressed as an average annual percentage change (AAPC) with a 95% confidence interval (CI). P < 0.05 defined statistical significance. Results: Of 928 million people, 104,743 PE-related deaths occurred in older adults with neoplasms (AAMR 11.4). The AAMR was higher in males (13.3 vs 10.1 in females; P < 0.01), Black (17.0 vs 11.2 in White, P < 0.000001), and the Midwest census region (12.3 vs 11.7 in NorthEast, the Midwest, and 10.4 in the South; P < 0.0001). The AAMR was similar in rural areas (11.4 vs 11.3 in urban areas, P < 0.000001). The overall PE-related AAMR in neoplasms increased from 8.7 to 14.1 (AAPC 4.03%; CI: 3.12- 5.23). Furthermore, the AAMR increased in males (AAPC 3.37%; CI: 1.61-6.6) and females (AAPC 4.53%; CI: 3.15-6.20). Similarly, it increased in Black (AAPC 3.14%; CI:2.42-4.07), White (AAPC 3.98%; CI:3.07-5.14), rural (AAPC 3.70%; CI: 2.69-5.39), urban (AAPC 4.24; CI: 3.44-5.23 ), and across all geographic census regions. Conclusions: Pulmonary embolism related mortality among older adults with neoplasms has risen steadily over the past two decades across all demographic and geographic groups. Given that cancer-associated thrombosis is a well-recognized and largely preventable complication, these findings suggest important gaps in the prevention, recognition, and management of PE in oncology populations at the health-system level. The consistent upward trend highlights an urgent need to strengthen thromboprophylaxis strategies, risk stratification, and early detection efforts in older adults with cancer to reduce avoidable mortality.