title: Ethnic differences in out-of-hospital fatal pulmonary embolism.
abstract: BACKGROUND
  In-hospital pulmonary embolism (PE) has been extensively studied in large populations; however, out-of-hospital fatal PE studies are rare. Here, we systematically evaluated a large number of decedents who suffered fatal PE outside of hospitals and were subsequently investigated by the New York City Office of Chief Medical Examiner.
  
  
  RESULTS
  A total of 578 consecutive out-of-hospital fatal PE cases were analyzed. All underwent autopsy, toxicology, microbiology, and genetic testing. Incidence rates and baseline characteristics were analyzed. Race-adjusted incidence rates of out-of-hospital fatal PE (per 100 000 people per year) were as follows: blacks, 3.73 (95% confidence interval, 3.31 to 4.11); whites, 1.15 (95% confidence interval, 0.96 to 1.33); and Hispanics, 0.93 (95% confidence interval, 0.72 to 1.10). Overall, obesity (body mass index ≥30 kg/m(2)) was 2.5- to 3-fold higher in fatal PE cases than in the New York City population as a whole. Carrier frequencies for prothrombin G20210A in fatal PE were 2- to 10-fold higher than reported frequencies in ethnically matched controls. Cumulative distribution curves showed that compared with whites, blacks and Hispanics died at significantly younger ages (P<0.001). Univariate and multiple linear regression analyses showed that in addition to nonwhite ethnicity, heterozygous carriers for factor V Leiden (P=0.001) and obesity (P=0.002) are significantly associated with younger age at death.
  
  
  CONCLUSIONS
  There are unique epidemiological differences in out-of-hospital fatal PE between ethnic groups in New York City.
authors.affiliation: Molecular Genetics Laboratory, Department of Forensic Biology, New York City Office of Chief Medical Examiner, New York, NY 10016, USA. ytang@ocme.nyc.gov
authors.forename: Yingying
authors.initials: Y
authors.lastname: Tang
authors.forename: Barbara
authors.initials: B
authors.lastname: Sampson
authors.forename: Stephanie
authors.initials: S
authors.lastname: Pack
authors.forename: Krunal
authors.initials: K
authors.lastname: Shah
authors.forename: Sung
authors.initials: S
authors.lastname: Yon Um
authors.forename: Dawei
authors.initials: D
authors.lastname: Wang
authors.forename: Tao
authors.initials: T
authors.lastname: Wang
authors.forename: Mechthild
authors.initials: M
authors.lastname: Prinz
mesh_terms: D000328:Adult; D001741:Black or African American / Q000706:statistics & numerical data; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D004632:Emergency Medical Services / Q000706:statistics & numerical data*; D005006:Ethnicity / Q000706:statistics & numerical data*; D005260:Female; D006630:Hispanic or Latino / Q000706:statistics & numerical data; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009519:New York City / Q000453:epidemiology; D011655:Pulmonary Embolism / Q000208:ethnology* / Q000401:mortality*; D017678:Sex Distribution; D054556:Venous Thromboembolism / Q000208:ethnology / Q000401:mortality; D044465:White People / Q000706:statistics & numerical data; D055815:Young Adult