Mortality trends and high-risk subgroups in hematologic malignancy-associated pulmonary embolism: a population-based analysis with complementary clinical data

Objective Pulmonary embolism (PE) is an important supportive care concern in patients with hematologic malignancies, particularly older adults with coexisting thrombotic, bleeding, comorbidity, and treatment-related risks. This study first characterized temporal and demographic patterns in U.S. population-level mortality records involving hematologic malignancies and PE, followed by a complementary single-center real-world analysis of 30-day all-cause mortality and potentially vulnerable age- and sex-defined subgroups. Methods Using CDC WONDER data, we analyzed U.S. mortality records from 1999 to 2023 and calculated age-adjusted mortality rates (AAMRs), annual percentage changes (APCs), and average annual percentage changes (AAPCs). We also analyzed a single-center retrospective cohort to describe 30-day all-cause mortality according to age and sex. Results Population-level mortality from hematologic malignancies declined from 1999 to 2023 (AAPC, −1.75%; 95% CI, −1.81% to −1.69%), whereas mortality records involving hematologic malignancies and PE increased, with a faster rise after 2017 (APC, 3.02%; 95% CI, 0.51%–5.58%). Higher mortality rates were observed among males, individuals aged ≥75 years, non-Hispanic Black individuals, residents of the Western United States, and nonmetropolitan populations. In the complementary clinical cohort, 30-day mortality was 30.77% among patients aged ≥75 years and 14.63% among those aged <75 years (P = 0.223), and 16.95% among males and 16.67% among females (P = 1.000). Conclusion Although overall mortality among patients with hematologic malignancies decreased over the past two decades, mortality involving hematologic malignancies and PE remained an important supportive care concern with persistent demographic and geographic disparities. Complementary real-world observations showed a numerically higher 30-day all-cause mortality in older patients, although the difference was not statistically significant. These findings support careful clinical assessment of potentially vulnerable patients and individualized supportive care that considers thrombotic risk, bleeding risk, comorbidity burden, and underlying malignancy characteristics.