ArticleFrontiers in cardiovascular medicine2026
Trends and disparities in mortality from infective endocarditis in the United States, 1999-2023: a nationwide analysis.
Article in Frontiers in cardiovascular medicine, 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: 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. Methods: 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. Results: 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). Conclusions: 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.
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