Background: Pulmonary embolism (PE) remains a major cause of cardiovascular morbidity and mortality worldwide. Administrative healthcare databases provide a valuable resource for evaluating long-term epidemiological trends and healthcare outcomes at the population level. This study aimed to assess temporal trends in PE incidence, management, and mortality in the Tuscany Region over a 12-year period, including the first two years of the COVID-19 pandemic.

Methods: We conducted a retrospective observational study using administrative hospital discharge data for all Tuscany residents aged ≥18 years hospitalized with PE between 2010 and 2021. Incidence rates, mortality outcomes, temporal trends, and determinants of one-year mortality were evaluated.

Results: Hospitalized PE incidence remained overall stable, with a slight non-significant decline from 64.7 to 60.9 per 100,000 population between 2010 and 2019 (p=0.152). Men younger than 75 years showed higher incidence rates, whereas women had higher incidence in older age groups. In-hospital and 30-day mortality significantly decreased during the pre-pandemic decade (p=0.001 and p=0.020, respectively), suggesting improvements in clinical management. During 2020, 30-day mortality increased significantly (12.4% vs 10.1%, p=0.029), while in-hospital mortality remained unchanged. One-year mortality was stable before the pandemic but increased in 2020 (32.6% vs 29.4%, p=0.037). Multivariable analysis identified older age, male sex, and comorbidity burden as independent predictors of one-year mortality.

Conclusions: Our study shows that Pulmonary Embolism persists as a relevant burden in Tuscany region, but with improvements in management over the past decade and a decisive change in pharmacological treatment. Gender-related differences emerge, highlighting the need for a gender-specific healthcare approach.

Gabriele Cerini is a Public Health physician specialized in Hygiene and Preventive Medicine. Since 2025, he has been working in Territorial Health Management at Azienda USL Toscana Centro, coordinating primary care services and contributing to the development of community-based healthcare. Previously, he worked as an Emergency Physician at Careggi University Hospital in Florence. His professional and research interests include healthcare organization, primary care, and the use of administrative healthcare databases to support health services research and evidence-based policy.