ArticleJACC. Advances2026
Substance Use-Associated Infective Endocarditis Mortality in Young U.S. Adults, 2018 to 2024.
Article in JACC. Advances, 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
backgroundSubstance use is a major driver of infective endocarditis (IE) in young U.S. adults, but recent national mortality trends remain unclear.
objectivesThe objective of the study was to characterize trends in substance use-associated IE (SU-IE) mortality among U.S. adults aged 25 to 44 years, with expanded and sensitivity analyses.
methodsWe analyzed Centers for Disease Control and Prevention Wide-ranging Online Data for Epidemiologic Research Multiple Cause of Death data from 2018 to 2024. IE-associated deaths were identified using International Classification of Diseases-10th Revision codes I33.0, I33.9, and I38; SU-IE required concurrent F11, F12, F13, F14, F15, or F19 codes. Mortality rates, overlap proportions, subgroup trends, and joinpoint annual percent changes with 95% CIs were assessed.
resultsAmong 9,745 IE-associated deaths in adults aged 25 to 44 years, 3,756/9,745 (38.5%) had substance-use overlap. Annual SU-IE deaths peaked at 655/1,604 (40.8%) in 2020 and 655/1,643 (39.9%) in 2021, then declined to 338/1,051 (32.2%) in 2024. The age-adjusted rate decreased from 0.75 per 100,000 (95% CI: 0.69-0.80) in 2021 to 0.41 (95% CI: 0.37-0.45) in 2024. Overlap decreased from 604/1,447 (41.7%) in 2018 to 338/1,051 (32.2%) in 2024. Significant post-2021 declines occurred among females (annual percent change, -23.59%), adults aged 25 to 34 years (-31.73%), adults aged 35 to 44 years (-12.55%), and White adults (-23.46%). American Indian or Alaska Native adults had the highest rates, and nonurban counties exceeded large central metropolitan counties. Among adults aged ≥25 years, 5,967/115,096 (5.2%) IE-associated deaths met the SU-IE criteria, including 2,211/5,967 (37.1%) among those aged ≥45 years.
conclusionsSU-IE mortality in young U.S. adults declined after 2021 but remained marked by demographic and geographic disparities.
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