Trends in the estimated case fatality rate of pulmonary embolism (PE) in the United States were obtained from the Bureau of the Census Compressed Mortality File and the National Hospital Discharge Survey. The estimated case fatality rate of PE increased from 1979 to 1989, then decreased through 1998. It increased exponentially with age and was higher in African-American than Caucasian patients (rate ratio 1.42; 95% confidence interval 1.40 to 1.44). The declining population mortality rate of PE from 1979 to 1989 appears to be due to a decreased incidence of PE, reflective of improved prophylaxis, whereas the continued declining population mortality rate of PE through 1998 reflects a decreased case fatality rate due to earlier and better management.