Trends and disparities in mortality from infective endocarditis in the United States, 1999-2023: a nationwide...

Infective endocarditis (IE) remains a life-threatening condition associated with substantial mortality. Over recent decades, evolving risk factors and treatment practices, yet contemporary population-level mortality patterns and the impact of the COVID-19 pandemic remain incompletely understood.

We analyzed national mortality data for IE in the United States from 1999 to 2023 using the National Vital Statistics System. Age-adjusted mortality rates (AAMRs) were calculated per 100,000 population standardized to the 2000 U.S. population. Analyses were stratified by sex, age, race/ethnicity, region, and urban-rural classification. Age-period-cohort models were used to explore temporal patterns, and excess mortality during 2019-2023 was estimated by extrapolating pre-pandemic (1999-2018) log-linear trends.

From 1999 to 2023, IE deaths increased from 5,580 to 6,901, while the AAMR declined from 3.16 to 2.58 per 100,000 (AAPC -0.78%, 95% CI -1.11 to -0.44). Declines were greater among women (AAPC -1.09%) than men (-0.55%), and in metropolitan areas compared with rural counties. Hispanic and Asian/Pacific Islander populations experienced the largest declines, whereas non-Hispanic Black adults showed slower improvements. During 2019-2023, 34,601 deaths were observed vs. 35,926 expected, corresponding to a difference of -1,325 deaths (-3.7%). Age-period-cohort analysis revealed a pandemic-related period effect with short-term increases in mortality during 2020-2021, and a cohort effect indicating attenuated long-term declines among younger adults (25-44 years).

Mortality from IE in the United States has declined overall since 1999, but disparities persist across sex, geography, urban-rural status, and race/ethnicity. Pandemic-related disruptions produced a discernible period effect, while younger cohorts demonstrated slower long-term improvements.