Temporal trends in mortality related to infective endocarditis and stroke in the United States

Introduction: Infective endocarditis (IE) remains a significant cause of mortality, and neurological complications-particularly stroke-are associated with worsened outcomes. However, temporal trends in mortality when both conditions co-occur remain underexplored. Aims: To analyze mortality trends in infective endocarditis with stroke as a contributing cause of death using the CDC Multiple Cause of Death (MCD) database from 1999 to 2020. Methods: A retrospective observational study was conducted using the CDC MCD database to assess mortality trends among individuals aged ≥25 years in the United States from 1999 to 2020. Deaths in which infective endocarditis (ICD-10: I33.0) was listed as the underlying cause and cerebral infarction (ICD-10: I63) as a contributing cause were analyzed. Data were stratified by age, sex, race, geographic region, and place of death. Age-adjusted mortality rates (AAMR) and annual percentage change (APC) were calculated. Results: Between 1999 and 2020, 1,761 deaths met the inclusion criteria. The AAMR for IE with stroke demonstrated an initial decline followed by a subsequent increase (APC: 8.30%; 95% CI: 0.74-16.42). Mortality was highest among males, White adults, and those dying in metropolitan areas and medical facilities. Disparities were observed across demographic and geographic subgroups. Conclusions:IE-associated stroke mortality shows a concerning upward trend, with significant disparities by sex, race, and location. These findings underscore the need for targeted prevention strategies and equitable healthcare access for high-risk populations.