Abstract Body (Do not enter title and authors here):
Background
Patients with infective endocarditis (IE) face an elevated risk of stroke; however, national trends in mortality related to both stroke and IE remain poorly characterized. This study examines contemporary mortality trends among adults aged ≥25 years in the United States with coexisting stroke and IE from 1999 to 2019.

Methods
We analyzed the mortality data by using the CDC WONDER mortality database, extracting age-adjusted mortality rates (AAMR) per 100,000 population. We identified cerebrovascular disease (stroke) using the ICD-10 codes I60–I69 and identified IE using ICD-10 codes B37.6, I33.0, I33.9, and I38. We included those fatalities in our analysis where both stroke and IE contributed to death. We comprehended the mortality trends by year, sex, race and ethnicity, census region, state, and metropolitan status. Joinpoint regression was used to calculate the annual percent change (APC) in AAMR with 95% confidence intervals.

Results
From 1999 to 2019, a total of 32,351 deaths occurred among individuals where cerebrovascular disease and IE contributed to the death, with an overall AAMR of 0.71/100,000. The overall AAMR decreased from 0.83 in 1999 to 0.76 in 2019 (AAPC: -0.53, p = 0.03), showing a decreasing trend from 1999 to 2015 (APC: 1.62, p = 0.016), and followed by a stable trend from 2015 to 2019 (APC: 3.96, p = 0.091). Men had a higher AAMR (0.80) than women (0.66). Racial disparities revealed that American Indians or Alaska Natives had the highest AAMR (0.90), followed by Blacks or African Americans (0.89), Whites (0.74), Hispanics or Latinos (0.48), and Asians or Pacific Islanders (0.39). Significant geographical variations were observed, with the Midwest region (0.81) and the state of Alabama (1.34) having the highest AAMR as compared to other regions and states. Non-metropolitan areas had a higher AAMR (0.82) than metropolitan areas (0.70).

Conclusion
Our study revealed that despite an overall decline in stroke and IE-related mortality between 1999 and 2019, mortality plateaued between 2015 and 2019. The geographical and sociodemographic disparities highlighted by our study are important for identifying and managing these vulnerable cohorts.