Temporal trends in hospital-recorded pulmonary embolism in England before, during and after the COVID-19 pandemic (2008-2024): a population-based observational study.

Background: COVID-19 infection increases the risk of pulmonary embolism (PE). Up-to-date reporting of hospitalisation rates for PE is needed to inform service planning and for benchmarking in light of the pandemic. Our primary aim was to quantify monthly trends in first-time, hospital-recorded PE across England from 2008 to 2024, with particular focus on the pandemic period. A secondary aim was to examine how these trends varied by age, sex, socioeconomic deprivation, and region, providing ongoing public access through an interactive online dashboard. Methods: We conducted an epidemiological population-based study of all first-time PE diagnoses using English national secondary care data from April 2008 to December 2024. Trends before and after the onset of the COVID-19 pandemic (March 2020) were compared, with analyses by age, sex, region, and deprivation. Findings: A total of 750,109 first-time PE admissions were identified. Age-standardised first-time hospital-recorded PE rates rose from 5.4 per 100,000 population in April 2008 to 8.5 in January 2020, spiked to 16.8 in January 2021 during the pandemic. The spike was largely accounted for by PEs where COVID-19 was a co-existing diagnosis. Rates have since declined, returning to pre-pandemic levels by early 2023 (e.g. March 2023, 8.6 per 100,000), and may be continuing to decline, subject to further updates. Regional and deprivation gradients persisted throughout but were more pronounced during the pandemic. Interpretation: Whilst incidence of hospital-recorded PE spiked during the COVID-19 pandemic, rates have since returned to levels observed immediately prior to the pre-pandemic. Whilst it is too early to determine whether the recent downward trend may begin to reverse some of the upward trend observed over the decade before the pandemic, continued surveillance of hospital-recorded PE reported via our online tool will keep these findings up to date. Ongoing monitoring of PE incidence by healthcare setting is important to undertake while clinical practice and policy on PE management pathways evolve, since it helps to support care planning; it also informs data-enabled clinical trials where PE is an outcome as well as the design of observational studies. Funding: This work was supported by the NIHR Biomedical Research Centre, Oxford and by Health Data Research UK.