# Trends and disparities in mortality from infective endocarditis in the United States, 1999–2023: a nationwide analysis

## TL;DR

Infective endocarditis mortality in the U.S. has decreased overall since 1999, but disparities remain among different groups, and the pandemic caused a temporary rise in deaths.

## Contribution

This study provides a nationwide analysis of IE mortality trends and disparities in the U.S., including the impact of the COVID-19 pandemic.

## Key findings

- IE mortality rates declined overall from 1999 to 2023, with the largest declines among women and in urban areas.
- Non-Hispanic Black adults and rural populations showed slower improvements in IE mortality.
- The pandemic caused a short-term increase in IE mortality, particularly among younger adults.

## Abstract

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.

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.

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).

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.