Abstract Body (Do not enter title and authors here): Background :Infective endocarditis (IE) is a life-threatening condition often complicated by septicemia, yet national mortality trends and disparities in IE-related septicemia deaths remain poorly characterized. This study aims to examine patterns in septicemia-associated mortality among adults with IE in the United States from 1999 to 2023.
Hypothesis: Septicemia-related mortality among adults with infective endocarditis has increased over time, with disparities by sex, age, race, region, and urbanization.
Methods: Death certificates from the CDC WONDER (Centers for Disease Control and Prevention Wide-Ranging OnLine Data for Epidemiologic Research) database were examined from 1999 to 2023 for adults aged ≥25 years. IE-related deaths were identified using ICD-10 codes (I33.0, I33.9, I38, and B37.6), and septicemia using (A40–A41). Age-adjusted mortality rates (AAMRs) per 100,000 population were calculated. Trends were assessed using Joinpoint regression to estimate annual percent change (APC) and average annual percent change (AAPC), stratified by sex, age, race/ethnicity, U.S. Census region, and urbanization.
Results: From 1999 to 2023, a total of 53,145 deaths were reported in individuals with septicemia-related deaths among IE patients in the US. The AAMR increased from 0.83 to 1.09 per 100,000 , with an accelerated rise after 2010 (APC: 3.58 ; 95% CI: 3.11– 4.79) after which it had a sharp decline between 2021 and 2023 (APC: -5.58 ; 95% CI: -9.48– -1.50). Men consistently had higher AAMRs than women, rising from 0.97 in 1999 to 1.35 in 2023, compared to women rising from 0.76 to 0.83 in the same period, with both showing steeper decreases after 2021. Most deaths (56.9%) occurred in those aged (65+). The South region had the highest AAMR (1.41) in 2021 with (AAPC: 1.35; 95% CI:0.98- 1.81). Black or African American individuals had the highest overall AAMRs (1.66), followed by NH White individuals (0.93), then Hispanic or Latino (0.71).
Conclusion: Septicemia-related mortality in IE patients rose notably until 2021, then declined. Higher rates were seen in men, older adults, Black individuals, the South, and non-metropolitan areas. Targeted efforts are needed to reduce these persistent disparities.