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A retrospective study presented at IDWeek found the U.S. age-adjusted infective endocarditis mortality rate edged down from about 4.2 to 4.1 deaths per 100,000 people between 1999 and 2024. The national figure masks increases among adults under 65, men and people in non-metropolitan areas; the researchers say the records cannot explain why those patterns occurred.
A retrospective study of CDC mortality records found that the U.S. age-adjusted death rate involving infective endocarditis changed little from 1999 to 2024, while rising among adults younger than 65, men and residents of non-metropolitan areas. The findings, presented by Mariapaula Ordonez Giraldo of AdventHealth Sebring at the IDWeek annual meeting, indicate that the near-flat national rate masks uneven trends.
Using records from the CDC WONDER database, investigators found that the national age-adjusted mortality rate went from about 4.2 deaths per 100,000 people in 1999 to 4.1 per 100,000 in 2024. The rate did not move steadily: it was stable or rose slightly in 1999–2005, fell significantly in 2005–2009, remained stable through 2018, rose sharply in 2018–2021 and then fell sharply in 2021–2024.
Changes differed by age. Rates fell among adults aged 65 and older, from 26.07 to 23.59 per 100,000, but rose among adults aged 15–44, from 0.60 to 0.84, and those aged 45–64, from 3.06 to 3.30. Rates also fell among women, from 3.95 to 3.41, while rising among men, from 4.64 to 4.90.
Geography showed another divide: the rate increased in non-metropolitan areas, from 4.35 to 4.95 per 100,000, and decreased in metropolitan areas, from 4.23 to 4.02. These figures describe changes between 1999 and 2024; the study did not establish what caused them.
Mortality Trends Differ Across Groups
The small change in the national rate can obscure worsening outcomes in particular populations. The reported increases among younger and middle-aged adults, men and people in non-metropolitan areas point to groups and locations that may merit closer study and attention from health services.
Endocarditis is an infection of the heart’s inner lining or valves. Ordonez Giraldo said timely recognition and coordinated care can be important, including input from infectious-disease specialists, cardiologists and cardiac surgeons when appropriate. She also identified addiction care as a potential part of care for patients whose disease is associated with substance use. The study measured mortality patterns, however, and did not test whether any particular intervention would reduce deaths.
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A Changing Pattern Over 25 Years
The study examined deaths from 1999 through 2024 and found several distinct periods rather than a consistent long-term decline. The sharp rise in 2018–2021 coincided with the COVID-19 pandemic. Ordonez Giraldo said prior work had described an early-pandemic drop in endocarditis diagnoses, followed by reports that patients hospitalized with the condition after COVID-19 were more medically complex and had worse outcomes than patients before the pandemic.
That timing does not show that the pandemic caused the mortality increase. Ordonez Giraldo said healthcare use and delivery changed substantially after 2020, but the study was not designed to identify the reasons for the observed shifts. She also said the increase among younger adults may fit a broader context of injection-drug-use-associated endocarditis and changing risk exposures, while cautioning that the analysis could not test that explanation.
“National averages may not tell the whole story.”
— Mariapaula Ordonez Giraldo, MD, of AdventHealth Sebring, speaking to MedPage Today
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Causes Behind the Shifts Remain Unknown
The analysis cannot explain why rates changed across time or among groups. CDC WONDER records include a death when infective endocarditis appears on the death certificate, whether or not it was listed as the underlying cause. The dataset did not provide individual-level clinical or behavioral information, so it cannot establish how substance use, access to care, patient complexity or other factors contributed.
The pandemic’s overlap with the 2018–2021 increase is a timing relationship, not proof of causation. The supplied report does not state whether the study has been published in a peer-reviewed journal, nor does it provide further detail on the statistical methods or uncertainty around individual subgroup estimates.
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Further Data Needed to Explain Rates
Ordonez Giraldo said further research using individual clinical and risk-factor data is needed to investigate the patterns and their possible causes. The findings also point to access to specialized care, particularly outside metropolitan areas, as an area for attention, though the study did not measure access directly or assess specific policy changes.
For now, the next step is better evidence on what is driving the diverging trends and whether differences in diagnosis, treatment or risk exposures help account for them. No specific follow-up study or policy action was detailed in the report.
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Key Questions
What did the study find about U.S. endocarditis mortality overall?
The age-adjusted rate changed from about 4.2 per 100,000 people in 1999 to 4.1 in 2024, a small net decline over the study period.
Which groups had rising mortality rates?
Rates rose among adults aged 15–44 and 45–64, among men, and in non-metropolitan areas. The study reported declines among adults aged 65 and older, women and residents of metropolitan areas.
Did the study identify why mortality increased in some groups?
No. The researchers said the mortality records lacked individual-level clinical and behavioral information needed to determine the causes of the trends.
Does the study show that COVID-19 caused the increase in deaths?
No. The sharp rise in 2018–2021 coincided with the pandemic, but the study does not establish that COVID-19 or pandemic-related changes caused it.
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