ArticleThe Lancet regional health. Europe2026
Socioeconomic disparities in long-term mortality after infective endocarditis in Denmark: a nationwide cohort study.
Article in The Lancet regional health. Europe, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: Socioeconomic position (SEP) influences several determinants of infective endocarditis (IE) progression. Whether IE mortality differs by SEP remains unclear. We examined 5-year mortality after IE by individual-level SEP. Methods: Using nationwide Danish registries, we identified patients with first-time IE (2010-2022). SEP was assessed by educational and affluence level, categorised as low, medium, and high. The Kaplan-Meier estimator provided 30-day, 1-, 3-, and 5-year mortality risks, risk differences, and risk ratios. Time-varying hazard ratios were derived from flexible parametric models. We estimated attendance at outpatient and dental follow-up visits (indicating adherence to follow-up) using the Aalen-Johansen estimator and modelled hospitalisation rate during follow-up (indicating comorbid disease burden) using a joint frailty model, treating death as a competing event in all models. Findings: The 5-year mortality by educational level was 63.1% (95% CI: 60.8%-65.2%) for low, 53.1% (95% CI: 51.3%-54.9%) for medium, and 45.8% (95% CI: 42.5%-48.8%) for high education. The excess mortality was particularly pronounced within the first 2 years. Within one year after discharge, 65.2% (95% CI: 62.9%-67.4%) of low, 73.6% (95% CI: 72.0%-75.2%) of medium, and 74.5% (95% CI: 71.8%-77.2%) of high-education patients had an outpatient contact. The corresponding five year dental visit proportions were 44.0% (95% CI: 41.6%-46.5%), 64.0% (95% CI: 62.2%-65.9%), and 74.0% (95% CI: 71.2%-76.9%), respectively. The hazard ratio for hospitalisations was 1.35 (95% CI: 1.25-1.49) when comparing low Interpretation: Patients with low SEP had higher IE mortality, particularly within the first 2 years. Reduced adherence to follow-up care and comorbid diseases may contribute to this. Determining how the excess mortality is directly linked to the IE episode warrants further investigation. Funding: Independent Research Fund Denmark (grant no. 3101-00102B) and Center for Population Medicine, Department of Clinical Epidemiology, Aarhus University.
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