Temporal Trends and Demographic Disparities in Mortality Involving Pulmonary Embolism and Diabetes Mellitus Among U.S. Adults Aged ≥25 Years, 1999–2024: A CDC WONDER Analysis

<title>Abstract</title> <p>Background Pulmonary embolism (PE) and diabetes mellitus (DM) contribute substantially to cardiovascular mortality, yet national data describing deaths involving both conditions remain limited. This study evaluated temporal trends and demographic disparities in PE and DM-related mortality among U.S. adults aged ≥ 25 years from 1999 to 2024. Methods The CDC WONDER Multiple Cause-of-Death database was analyzed for death certificates listing PE (ICD-10 code I26) and DM (ICD-10 codes E10–E14) as underlying or contributing causes of death. Age-adjusted mortality rates (AAMRs) per 100,000 population were calculated using the 2000 U.S. standard population. Joinpoint regression estimated annual percent change (APC) and average annual percent change (AAPC) with 95% confidence intervals (CIs), stratified by sex, age, race/ethnicity, census region, urbanization, state, and place of death. Results From 1999 to 2024, 82,180 deaths involving both PE and DM were recorded. The overall AAMR increased from 1.08 in 1999 to 1.88 in 2024, with a significant AAPC of 1.98% (95% CI: 1.10–2.87; p &lt; 0.001). Mortality increased modestly from 1999 to 2018, accelerated sharply from 2018 to 2021, and declined significantly from 2021 to 2024. Males had higher and faster-rising AAMRs than females. Black or African American individuals had the highest AAMRs, while adults aged ≥ 65 years carried the greatest absolute burden. The South had the highest regional AAMR by 2024, and non-metropolitan areas had higher rates than metropolitan areas through 2020. Conclusion Pulmonary embolism and Diabetes mellitus-related mortality showed an overall increase among U.S. adults aged ≥ 25 years from 1999 to 2024, with substantial sex, racial, age, regional, and urban-rural disparities. Targeted prevention, timely recognition of PE, optimized diabetes management, and equitable access to healthcare are needed to reduce these disparities and the overall mortality burden.</p>