Substance use disorder may be linked to more deaths from infective endocarditis among people ages 25 to 44, according to a new study published in the Journal of the American Heart Association .
Research Highlights:
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Mortality rates related to infective endocarditis declined in most adults in the U.S. over the past two decades, but accelerated among young adults ages 25 to 44, according to new research published today in the Journal of the American Heart Association , an open access, peer-reviewed journal of the American Heart Association.
Infective endocarditis , also called bacterial endocarditis , is an infection caused by bacteria that enter the bloodstream and settle on the lining of the heart, a heart valve, or a blood vessel. The disease is rare, however, people with previous valve surgeries, heart valve abnormalities, artificial valves, congenital heart defects or previous infective endocarditis are at greater risk of developing it. It can also be a complication of injecting illicit drugs.
"The findings of our study raise a public health concern, especially since deaths in younger age groups are increasing," said the study’s senior author, Sudarshan Balla, MD, associate professor of medicine at the Heart and Vascular Institute of West Virginia University at JW Ruby Memorial Hospital in Morgantown, West Virginia. "We speculate that this acceleration was likely due, for the most part, to the opioid crisis that has affected several states and has primarily affected younger adults."
The researchers examined death certificate data from the Centers for Disease Control and Prevention’s (CDC) Multiple Causes of Death dataset, which contains death rates and population counts for all U.S. counties. They looked for national trends in deaths caused by infective endocarditis, as well as differences in deaths related to age, sex, race and geography between states between 1999 and 2020. The researchers also looked at the association with the disorder substance use, considering the emergence of the opioid epidemic during the study period.
The analysis found:
- Over the 21-year period analyzed, mortality rates from infective endocarditis decreased overall in the US.
- Mortality rates increased significantly among young adults, with an average annual change of more than 5% for the 25- to 34-year-old group and more than 2% for the 35- to 44-year-old group.
- In the 45-54 age group, mortality rates remained stagnant at 0.5% and there was a significant decline among people aged 55 and older.
- Substance use disorder associated with multiple causes of death increased dramatically: 2- to 7-fold among the 25- to 44-year-old age group.
- Kentucky, Tennessee, and West Virginia showed an acceleration of deaths caused by infective endocarditis in contrast to other states with a predominant decline or no change.
Figure: Comparison of crude mortality rates in different age groups related to infective endocarditis as underlying cause of death (A) and infective endocarditis and underlying substance use disorders (listed as underlying cause of death and comorbidities, respectively ) (B).
"We found that substance use was listed as a contributing cause that could explain the higher mortality rates in the younger age groups and also in the states among those who died due to endocarditis," Balla said.
The study’s researchers call the increase in infective endocarditis as an underlying cause of death in adults ages 25 to 44 years "alarming" and recommend more research to identify the reasons for these trends among young adults and in the three states. Researchers speculate the increase is related to the opioid crisis that has hit several states and primarily affects younger adults.
"Comprehensive care plans for those receiving treatment for infective endocarditis should also include screening and treatment for substance use disorder," Balla said.
To address intravenous drug use, some states have initiated harm reduction programs, which are public health efforts to reduce the harms caused by substance use and drug abuse, such as the increased risk of infectious diseases such as HIV. , viral hepatitis and bacterial and fungal infections. “Whether these programs will have an impact is yet to be determined,” Balla said.
Researchers were limited in the medical details they could collect due to the use of death certificate data, which can contain inaccuracies such as errors in diagnosis, data entry and cause of death. For similar reasons, researchers were unable to determine a direct cause-and-effect relationship between increased deaths caused by infective endocarditis in younger adult LTs and substance use disorder.
Study details and design:
The study used CDC’s Wide Range Online Data for Epidemiologic Research (WONDER) database to analyze death certificates and multiple causes of death. Infective endocarditis and substance use disorder were identified according to the criteria of the International Classification of Diseases, Tenth Revision.
The age-adjusted mortality rate related to infective endocarditis was 26 per million people in 1999 and 22 per million people in 2020, representing a significant decrease in mortality rates related to infective endocarditis, with a average annual percentage change of -0.8.
Conclusions Age-adjusted mortality rates from infective endocarditis (IE) in the general population have decreased. The marked acceleration of mortality in the 25 to 44 age group is cause for alarm. Accelerating regional differences in IE mortality rates were observed in Kentucky, Tennessee, and West Virginia. We speculate that this acceleration was likely primarily due to the opioid crisis that has affected several states and has primarily affected younger adults. |
Clinical perspective
What’s new?
In this national cross-sectional study, despite an overall downward trend in infective endocarditis-related mortality, an acceleration of deaths was observed among younger adults aged 25 to 44 years.
In younger age groups, a notable increase in the prevalence of substance use disorder was observed in those with infective endocarditis as the underlying cause of death.
State-level trends revealed that Kentucky, Tennessee, and West Virginia had a dramatic increase in infective endocarditis-related mortality.
What are the clinical implications?
The acceleration in deaths from infective endocarditis observed among adults aged 25 to 44 years is cause for concern.
More studies are needed to identify the reasons for increased mortality in younger age groups and in the mentioned states.
It remains to be seen whether harm reduction programs addressing injection drug use will have an impact on the epidemiology of infective endocarditis.
