Epidemiology of pulmonary embolism in China, 2021: a nationwide hospital-based study

Abstract

Background: Pulmonary embolism (PE) as a preventable and potentially fatal noncommunicable disease was believed to have a lower incidence in Asian populations compared to Western populations. However, the incidence and mortality rates of PE in China and the impact of venous thromboembolism (VTE) prevention system constructions on PE still lack nationwide evidence.

Methods: For this nationwide hospital-based observational study, we used data from the National Hospital Quality Monitoring System (HQMS) and public database in China. We estimated the incidence and in-hospital mortality rates of PE by age group, sex, and regions of geographical and socioeconomic level. VTE prevention and management system constructions were quantified by geographical density. We then calculated the incidence and mortality rates in different conditions of VTE prevention and management system construction.

Findings: During the 12 months period between January and December 2021, a total number of 200,112 PE patients and 14,123 deaths were recorded from 5101 hospitals in the HQMS database. The incidence of PE was 14.19 (200,112, 95% CI 14.13-14.26) per 100,000 population and the mortality rate was 1.00 (95% CI 0.99-1.02) per 100,000 population. The incidence of PE was higher in male patients (14.43 per 100,000 population) than in female patients (13.95 per 100,000 population). Disparities of incidence and mortality rates were shown within age groups and geographical regions. The incidence and mortality rates of PE showed decreasing trend with increasing geographical density of VTE-related facilities and VTE prevention system developments.

Interpretation: China had a substantially large number of PE patients. The incidence and mortality rates of PE showed disparities in terms of sex, age, and geography. The incidence and mortality rates of PE decrease across regions with increasing levels of socioeconomic development, potentially influenced by the existing VTE prevention and management systems. Optimizing the health policies and healthcare investment in VTE prevention may help reduce the disease burden of PE.

Funding: CAMS Innovation Fund for Medical Sciences (CIFMS) (2023-I2M-A-014); National High Level Hospital Clinical Research Funding (2022-NHLHCRF-LX-01-0108); National Key Research and Development Program of China (2023YFC2507200); Discipline-Innovation and Talent-Introduction Program for Colleges and Universities (111 Plan, B23038).

Keywords: Disease burden; Incidence; Mortality; Pulmonary embolism; VTE prevention.

Fig. 1

Incidence and mortality heatmap of the age groups by sex, geographic area, and HDI in China. ∗Suggests that there is no statistically significant linear relationship between HDI level and PE incidence (p = 0.25). ^#Suggests that there is no statistically significant linear relationship between HDI level and PE mortality (p = 0.29). Abbreviation: HDI, Human Development Index.

Fig. 2

Geographic distribution of PE incidence and mortality in China. a: The incidence rates of PE were higher in the northern regions compared to the southern regions, with the northwest and southwest regions showing higher incidence than the eastern areas. b: The mortality rates of PE were greater in the northern than in the southern regions. Notably, the southwest, northwest, and northeast regions exhibited higher mortality rates than others. Abbreviation: PE, pulmonary embolism.

Fig. 3

PE-related incidence and mortality rates in PE patients in relation to the geographical densities of VTE-related facilities and prevention systems in China, 2021. Geographical densities per 1000 square kilometres were log-transformed. Detailed geographical densities of each indicator were listed in Appendix Table S7. Error bars show 95% CIs of each rate. The definitions of each indicator of VTE-related facilities and prevention systems were as follows: PE diagnosis and treatment institutions Institutions was defined as the total number of secondary and tertiary public hospitals across Mainland China. Hospital bed counts represented the total number of actual and functional beds available at the end of the year. The hospitalizations were defined as the total number of patients discharged throughout the year of 2021. Professional healthcare providers included licensed physicians, assistant physicians, registered nurses, pharmacists, technicians, and interns, who provide medical care to patients. Thromboprophylaxis management denoted the number of hospitals implementing VTE prevention system according to the NCIS survey. VTE program participation implied the total number of hospitals engaged in the National VTE prevention program in China. VTE Centres of Excellence indicated that the institution possesses comprehensive resources and capabilities to effectively support the prevention and management of VTE. QC staffs were defined as the total numbers of specialized personnel engaged in medical quality management control. Abbreviations: PE, pulmonary embolism; VTE, venous thromboembolism; CI, confidence interval; NCIS, National Clinical Improvement System; QC, quality control.