National Mortality Trends Involving Pulmonary Embolism and Sleep Apnea in the United States, 1999-2023

Document Type

Conference Proceeding

Publication Date

5-2026

Publication Title

American Journal of Respiratory and Critical Care Medicine

Abstract

Rationale: Sleep apnea (SA) is a common chronic sleep-related breathing disorder marked by recurrent upper airway obstruction and intermittent hypoxia. Pulmonary embolism (PE) is a rapidly fatal condition responsible for approximately 100,000 deaths annually in the United States (U.S.). Although clinical studies suggest an association between SA and PE, population-level data describing their combined mortality burden remain limited. This study evaluated national mortality trends involving both conditions and identified high-risk demographic groups. Methods: De-identified mortality data from the CDC WONDER Multiple Cause of Death database (1999-2023) were analyzed using ICD-10 codes for SA and PE. Age-adjusted mortality rates (AAMRs) per 1,000,000 population were standardized to the 2000 U.S. census population. Temporal trends were assessed using Joinpoint regression to calculate annual percent change (APC) and average annual percent change (AAPC) with 95% confidence intervals (CIs). Statistical significance was defined as p < 0.05. Results: Between 1999 and 2023, 7,906 deaths were attributed to concurrent SA and PE, with AAMR increasing from 0.49 to 4.97 per million (AAPC = +9.19; 95% CI: 8.53-10.12). Males had higher AAMRs than females (AAPC = +9.48; 95% CI: 8.80-10.50 vs. +8.76; 95% CI: 7.89- 10.13). Across racial groups, mortality increased in all categories, with the steepest rise among non-Hispanic (NH) Whites (AAPC = +9.72; 95% CI: 9.04-10.73), followed by NH Black/African Americans (AAPC = +7.39; 95% CI: 5.80-9.60). All U.S. regions exhibited rising trends, most pronounced in the West (AAPC = +11.11; 95% CI: 9.60-13.30), while the South had the highest overall AAMR (19.62). Age-stratified analysis showed the greatest increase among adults ≥65 years (AAPC = +10.91; 95% CI: 10.15-12.15). Nonmetropolitan areas consistently had higher AAMRs (22.45), whereas metropolitan areas showed steeper growth (AAPC = +9.69; 95% CI: 8.19-13.60). Conclusions: Mortality involving coexisting SA and PE has risen markedly, particularly among NH White males aged ≥65 years residing in metropolitan areas of the Western U.S. These trends reflect persistent disparities in healthcare access, socioeconomic standing, and insurance or immigration status. Targeted screening, early recognition, thromboprophylaxis, and region-specific preventive strategies are essential to reduce preventable deaths and improve outcomes in this growing high-risk population.

Volume

212

Issue

S1

First Page

S4701

Last Page

A4702

Comments

Ali F, Abdullah M, Siddique M, Ismail U, Sohail A, Haider F, et al. [Dalal B]. National mortality trends involving pulmonary embolism and sleep apnea in the United States, 1999-2023. Am J Respir Crit Care Med. 2026 May;212(S1):S4701-S4702. doi:10.1093/ajrccm/aamag162.6300

DOI

10.1093/ajrccm/aamag162.6300

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