Opioid crisis likely spurred rise in infective endocarditis among young adults
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Key takeaways:
- Data show an acceleration in U.S. deaths due to infective endocarditis among adults aged 25 to 44 years.
- State-level trends show Kentucky, Tennessee and West Virginia had the largest increases in deaths.
CDC data show a spike in infective endocarditis deaths among young adults despite an overall decline in such deaths from 1999 to 2020, with researchers citing the role of comorbid opioid use disorder.
“Our study findings raise a public health concern, especially since the deaths in younger age groups are on the rise,” Sudarshan Balla, MD, associate professor of medicine at the West Virginia University Heart and Vascular Institute at J.W. Ruby Hospital in Morgantown, West Virginia, said in a press release. “We speculate that this acceleration was likely, in the most part, due to the opioid crisis that has engulfed several states and involved principally younger adults.”
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Infective endocarditis is an uncommon bacterial infection of the heart that is increasingly associated with injection drug use. Other risk factors include heart valve disease or previous heart valve surgery and congenital heart disease, according to the American Heart Association.
In a cross-sectional study, Balla and colleagues used the CDC’s Wide-ranging Online Data for Epidemiologic Research (WONDER) multiple causes of death database to assess deaths within the U.S. with infective endocarditis listed as the underlying cause from 1999 to 2020, while also analyzing any mentions of substance use disorders. Researchers investigated the trends in overall infective endocarditis-related, age-adjusted mortality rates, stratified by sex, race and urbanicity, state-level trends and infective endocarditis and substance use disorder in different age groups.
The findings were published in the Journal of the American Heart Association.
From 1999 to 2000, infective endocarditis-related age-adjusted mortality rates declined; however, infective endocarditis-related crude mortality accelerated significantly among adults aged 25 to 34 years (average annual percentage change, 5.4; 95% CI, 3.1-7.7; P < .001) and adults aged 45 to 54 years (average annual percentage change, 2.3; 95% CI, 1.3-3.3; P < .001). Rates remained stagnant among adults aged 45 to 54 years and declined among adults aged 55 years and older.
Researchers observed a concomitant substance use disorder as multiple causes of death in those with infective endocarditis increased “drastically” among adults aged 25 to 44 years (P < .001). In state-level analyses, Kentucky, Tennessee and West Virginia had an acceleration in age-adjusted mortality rates in contrast to other states, where researchers observed declines or static trends for infective endocarditis.
“We found that substance use was listed as a contributing cause that could explain the higher death rates in the younger age groups and also in the states in those who died due to endocarditis,” Balla said in the release. “Comprehensive care plans for those treated for infective endocarditis should also include screening and treatment for substance use disorder.”
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