title: [Pulmonary Embolism in Portugal: Epidemiology and In-Hospital Mortality].
abstract: BACKGROUND
  In Portugal, the epidemiology of acute pulmonary embolism is poorly understood. In this study, we sought to characterize the pulmonary embolism from the hospital data and evaluate its in-hospital mortality and respective prognostic factors.
  
  
  METHODS
  The study used diagnostic related groups data from National Health System hospitals from 2003 to 2013 and National Statistics Institute population data to establish the evolution of admissions with the diagnosis of pulmonary embolism, their inhospital mortality rates and the population incidence rates. Diagnosis-related group microdata were used in a logit regression modeling in-hospital mortality as a function of individual characteristics and context variables.
  
  
  RESULTS
  Between 2003 and 2013 there were 35,200 episodes of hospitalization in patients with 18 or more years in which one of the diagnoses was pulmonary embolism (primary diagnosis in 67% of cases). The estimated incidence rate in 2013 was 35/100,000 population (≥ 18 years). Between 2003 and 2013, the annual number of episodes kept increasing, but the in-hospital mortality rate decreased (from 31.8% to 17% for all cases and from 25% to 11.2% when pulmonary embolism was the main diagnosis). The probability of death decreases when there is a computerized tomography scan registry or when patients are females and increases with age and the presence of co-morbidities.
  
  
  CONCLUSIONS
  In the last decade there was an increased incidence of pulmonary embolism likely related to an increased number of dependents and bedridden. However, there was a in-hospital mortality reduction of such size that the actual mortality in the general population was reduced. One possible explanation is that there has been an increase in episodes of pulmonary embolism with incrementally lower levels of severity, due to the greater capacity of diagnosis of less severe cases. Another possible explanation is greater effectiveness of hospital care. According to the logistic regression analysis, improvements in hospital care effectiveness in recent years are primarily responsible for the mortality reduction.
  
  
  CONCLUSIONS
  About 79% of the reduction of in-hospital mortality of pulmonary embolism between 2003 and 2013 can be attributed to greater effectiveness of hospital care and the rest to the favorable change in patient characteristics associated with risk of death.
authors.affiliation: Centro de Estudos de Medicina Baseada na Evidência. Faculdade de Medicina. Universidade de Lisboa. Lisboa. Portugal. Laboratório de Farmacologia Clínica e Terapêutica. Faculdade de Medicina. Universidade de Lisboa. Lisboa. Portugal. Unidade de Farmacologia Clínica. Centro Hospitalar Lisboa Central. Lisboa. Portugal.
authors.forename: Miguel
authors.initials: M
authors.lastname: Gouveia
authors.affiliation: Centro de Estudos de Medicina Baseada na Evidência. Faculdade de Medicina. Universidade de Lisboa. Lisboa. Portugal. erviço de Medicina II. Centro Hospitalar Lisboa Norte. Lisboa. Portugal.
authors.forename: Luís
authors.initials: L
authors.lastname: Pinheiro
authors.affiliation: Centro de Estudos de Medicina Baseada na Evidência. Faculdade de Medicina. Universidade de Lisboa. Lisboa. Portugal. Laboratório de Farmacologia Clínica e Terapêutica. Faculdade de Medicina. Universidade de Lisboa. Lisboa. Portugal. Unidade de Farmacologia Clínica. Instituto de Medicina Molecular. Faculdade de Medicina. Universidade de Lisboa. Lisboa. Portugal.
authors.forename: João
authors.initials: J
authors.lastname: Costa
authors.affiliation: Centro de Estudos de Medicina Baseada na Evidência. Faculdade de Medicina. Universidade de Lisboa. Lisboa. Portugal. Laboratório de Farmacologia Clínica e Terapêutica. Faculdade de Medicina. Universidade de Lisboa. Lisboa. Portugal. Unidade de Farmacologia Clínica. Centro Hospitalar Lisboa Central. Lisboa. Portugal. Portugal.
authors.forename: Margarida
authors.initials: M
authors.lastname: Borges
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D011174:Portugal / Q000453:epidemiology; D011379:Prognosis; D011655:Pulmonary Embolism / Q000453:epidemiology*; D013997:Time Factors; D055815:Young Adult