Young, white PWIDs increasingly admitted for infectious endocarditis
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The proportion of infectious endocarditis hospitalizations linked to injection drug use increased from 2000 to 2013, according to a recently published retrospective analysis.
These patients also are more often white, female and aged 15 to 34 years, according to Alysse G. Wurcel, MD, assistant professor at Tufts University School of Medicine, and colleagues, suggesting a gradually increasing epidemic of injection drug use (IDU) within this demographic.
“These infections are dangerous and often need surgery, and PWIDs frequently get these infections,” Wurcel said in a press release. “We’re seeing across the country that IDU is not necessarily an urban or an impoverished community issue. The racial, age and gender distributions are changing.”
Using the Health Care and Utilization Project 2000-2013 National Inpatient Samples database, Wurcel and colleagues reviewed discharge data sampled from community hospitals in participating states. They scanned for ICD-9 codes representing admissions aged 15 to 64 years with infectious endocarditis and excluded those with specific endocarditis risk factors that may have preceded IDU, such as rheumatic heart disease or congenital heart disease. The researchers then conducted statistical analyses to describe the prevalence and demographics of IDU-related hospitalizations.
Wurcel and colleagues identified 16,206 patients with qualifying ICD-9 codes admitted from 2000 to 2013, with more admissions for infectious endocarditis occurring over the study period. The proportion of IDU-related admissions remained stable at 7% to 8% until 2008 when it decreased to 6.1%, and then increased to 12.1% in 2013.
The percentage of IDU cases attributed to patients aged 15 to 34 years increased from 27.7% to 42% (P < .001), and decreased for adults aged 35 to 54 years during the same time period (67.2% to 39.9%; P < .001). Cases also occurred more frequently among whites during the study period (40.2% to 68.9%; P < .001), an increase which was even more pronounced when focusing the analysis to whites who were younger (P < .001). Although only 40.9% of the overall IDU-related infectious endocarditis cases were women, this proportion increased to 53% for the younger age group.
These trends appear similar to those previously associated with nationwide prescription opioid, heroin, HCV and overdose epidemics, the researchers wrote, and are worth consideration due to the high mortality of infectious endocarditis and the major risks for bloodborne diseases due to IDU.
“We think the findings are a signal that we need more programs in place trying to help prevent these types of infections from happening, because they are so deadly and costly to the health care system,” Wurcel said in the release. – by Dave Muoio
Disclosure: The researchers report no relevant financial disclosures.