Trends of infective endocarditis mortality in young adult population of US: A concerning rise and its association with substance abuse.

Background: Substance Abuse (SA) is associated with Infective Endocarditis (IE) morbidity and mortality in the young adult population of the US. However, limited data is available for trends and disparities related to IE mortality and its association with SA in the young adult US population. Methods: Data from the Centers for Disease Control and Prevention Wide-ranging Online Data for Epidemiologic Research were analyzed from 1999 to 2022 for IE and SA-IE-related mortality in young adults aged 15 to 44 in the US. Age-adjusted mortality rates (AAMR) per 1000,000 people were used to calculate annual percent changes (APC) using Joinpoint regression analysis. Trends were stratified by sex, race/ethnicity, age groups, census region, urbanization classification, and states. Results: IE caused 22,614 deaths in the young adult population of the US between 1999 and 2022. 7235 (32.0 %) of these deaths were associated with SA. AAMR for IE-associated mortality initially decreased from 6.2 in 1999 to 4.7 in 2010. Following that it increased by almost 3 folds to reach 13.5 in 2020 and 2021. SA-IE followed a similar trend, increasing more than 5 folds from an AAMR of 1.0 in 2010 to 5.4 by 2018. Between 1999 and 2009, 15-22 % of all IE deaths were associated with SA annually, which increased to >40 % for 2016-2022. Men had higher AAMR for IE though women witnessed a bigger jump in SA-associated IE mortality. Non-Hispanic American Indian or Alaskan natives, South region, and rural population had a worse increase. Conclusions: IE mortality in the young adult population of the US has increased from 2010 onwards with a concerning rise in SA and IE-associated deaths.