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A retrospective analysis of CDC death records found that the U.S. age-adjusted infective endocarditis mortality rate changed only slightly, from about 4.2 per 100,000 people in 1999 to 4.1 in 2024. The overall figure obscured rising rates among younger and middle-aged adults, men, and people in non-metropolitan areas; the study cannot explain why those differences occurred.
A retrospective study of U.S. death records found that the national age-adjusted mortality rate involving infective endocarditis edged down only slightly, from about 4.2 per 100,000 people in 1999 to 4.1 in 2024. Presented by Mariapaula Ordonez Giraldo, MD, at the IDWeek meeting, the analysis also found rising rates among younger and middle-aged adults, men, and people living in non-metropolitan areas, trends that the national average does not show.
The investigators used CDC WONDER mortality records to track deaths in which infective endocarditis was listed on the death certificate. The rate did not move steadily: it was stable or slightly higher from 1999 to 2005, declined significantly through 2009, remained stable until 2018, rose sharply from 2018 to 2021, and then fell sharply through 2024. The study reports these as population-level trends, not evidence of what caused them.
Results differed by age. From 1999 to 2024, the age-adjusted rate fell among adults 65 and older, from 26.07 to 23.59 per 100,000. It rose among adults ages 15–44, from 0.60 to 0.84, and among those ages 45–64, from 3.06 to 3.30 per 100,000.
The analysis also found a decline among women, from 3.95 to 3.41 per 100,000, while the rate among men rose from 4.64 to 4.90. In metropolitan areas it fell from 4.23 to 4.02; in non-metropolitan areas it increased from 4.35 to 4.95 per 100,000. The report was published by MedPage Today on October 22, 2026, in coverage of the meeting.
The National Rate Masks Uneven Trends
The near-flat national rate can obscure changes among groups whose outcomes moved in different directions. The reported increases among younger and middle-aged adults, men, and residents of non-metropolitan areas point to populations and places that may warrant closer examination. The findings do not establish that any group’s risk rose for a particular reason, but they show why an overall figure alone may give an incomplete account of mortality patterns.
For clinicians and health planners, the geographic difference also puts access to specialized care on the agenda, although this study did not measure access or link it to individual deaths. Ordonez Giraldo said infective endocarditis calls for timely recognition and multidisciplinary care, including infectious diseases, cardiology, and cardiac surgery expertise when appropriate. She also identified addiction care as relevant for patients whose disease is associated with substance use. These are potential opportunities she described, not interventions tested by the analysis.
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How the 25-Year Trend Shifted
Infective endocarditis is an infection involving the heart’s inner lining or valves. The study’s measure is a mortality rate based on death certificates, not a count of newly diagnosed cases or a measure limited to deaths where endocarditis was identified as the underlying cause. A death was included if infective endocarditis appeared on the certificate.
The time pattern included a marked rise from 2018 to 2021, followed by a decline through 2024. Ordonez Giraldo noted that the increase coincided with the COVID-19 pandemic. She cited prior work reporting fewer diagnoses early in the pandemic, potentially reflecting patients avoiding medical care, and later reports of patients admitted with endocarditis after COVID-19 having greater medical complexity and worse outcomes than before. The current analysis did not test whether pandemic-related changes caused its mortality pattern.
“National averages may not tell the whole story.”
— Mariapaula Ordonez Giraldo, MD, of AdventHealth Sebring, speaking to MedPage Today
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The Data Cannot Explain Causes
The analysis cannot determine why rates rose in some groups or fell in others. Its death-certificate data contained no individual-level clinical or behavioral information, and the researchers said explanations for the trends were outside the study’s scope. The figures also include deaths where endocarditis was recorded anywhere on the certificate, rather than only deaths where it was the underlying cause.
Ordonez Giraldo said the increase among younger adults may occur in the broader context of injection-drug-use-associated endocarditis and changing risk exposures; this was a possible explanation, not a finding established by the data. The pandemic’s coincidence with the 2018–2021 rise likewise does not show that COVID-19 or changes in health care caused it. The analysis does not identify the reasons for the non-metropolitan trend or assess access to care directly.
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More Detailed Studies Are Needed
The next research step, according to Ordonez Giraldo, is to examine individual-level clinical and risk-factor data to better understand what may be behind the different trends. Such work could help distinguish the roles of patient characteristics, risk exposures, changes in diagnosis and care, and access to specialist services; none of those explanations is resolved by the current population-level analysis.
For now, the study offers a 25-year mortality picture and highlights disparities for further investigation. It does not report a tested policy response or a confirmed schedule for follow-up research. The findings were presented at IDWeek, and further evidence will be needed to establish why rates diverged and which measures, if any, would reduce deaths.
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Key Questions
What did the study find about U.S. endocarditis mortality overall?
The age-adjusted rate changed only slightly, from about 4.2 per 100,000 people in 1999 to 4.1 in 2024, according to the CDC WONDER analysis.
Which groups had rising mortality rates?
Between 1999 and 2024, rates rose among adults ages 15–44 and 45–64, among men, and in non-metropolitan areas. Rates fell among adults 65 and older, women, and people in metropolitan areas.
Did the study identify why rates rose in some groups?
No. The analysis used death-certificate records and lacked individual clinical and behavioral data needed to establish causes. Possible explanations mentioned by the presenter were not proven by the study.
How did the researchers define an included death?
A death was included when infective endocarditis appeared on the death certificate, even if it was not recorded as the underlying cause.
What research is needed next?
Ordonez Giraldo called for studies using individual-level clinical and risk-factor information to investigate the mechanisms behind the different age, sex, and geographic patterns.
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