Substance use disorder may be linked to more deaths from infective endocarditis among people ages 25-44, finds a new study.

Death rates related to infective endocarditis declined in most adults across the US within the last two decades, yet accelerated among young adults ages 25 to 44 years old, according to new research published in the Journal of the American Heart Association.

Infective endocarditis, also called bacterial endocarditis, is rare; however, people with previous valve surgeries, heart valve abnormalities, artificial valves, congenital heart defects, or previous infective endocarditis have a greater risk of developing it. It can also be a complication of injecting illicit drugs.

“Our study findings raise a public health concern, especially since the deaths in younger age groups are on the rise,” says study lead author Sudarshan Balla, MD, an associate professor of medicine at the West Virginia University Heart and Vascular Institute at J.W. Ruby Memorial Hospital, in a 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.”

Researchers examined death certificate data from the Centers for Disease Control and Prevention’s (CDC) Multiple Cause 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, plus differences in deaths related to age, sex, race, and geography among states from 1999-2020. Researchers also analyzed the association with substance use disorder, considering the emergence of the opioid epidemic during the study’s time frame.

The analysis found:

  • In the 21-year period analyzed, infective endocarditis death rates declined overall in the US.
  • Death rates increased significantly for young adults, at an average annual change of more than 5% for the 25-34 age group and more than 2% for the 35-44 age group.
  • In the 45-54 age category, death rates remained stagnant at 0.5%, and there was a significant decline among those aged 55 and older.
  • Substance use disorder associated with multiple causes of death increased drastically—between two-fold and seven-fold among the 25-44 age group.
  • Kentucky, Tennessee, and West Virginia showed an acceleration in deaths caused by infective endocarditis in contrast to other states with either a predominant decline or no change.

“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 says in a release.

The study researchers call the rise of infective endocarditis as the underlying cause of death in adults 25-44 years old “alarming” and recommend more investigation to identify the reasons for these trends among young adults and in the three states noted. Researchers speculate the increase is connected to the opioid crisis that has engulfed several states and involves primarily younger adults.

“Comprehensive care plans for those treated for infective endocarditis should also include screening and treatment for substance use disorder,” Balla says in a release.

To address intravenous drug use, some states have started harm reduction programs, which are public health efforts to reduce the harm from substance use and drug abuse, such as increased risk of infectious diseases like HIV, viral hepatitis, and bacterial and fungal infections. “Whether these programs make an impact is yet to be determined,” Balla says in a release.

Researchers were limited in the medical details they could collect because of the use of death certificate data, which may contain inaccuracies, such as errors in diagnosis, data entry, and cause of death. For similar reasons, researchers could not determine a direct cause-and-effect relationship between the rise in deaths caused by infective endocarditis in younger adults and substance use disorder.   

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