Impact of Sex and Age on Trends of Mortality From Infective Endocarditis in High-Income Countries.

Background: Characteristics of infective endocarditis vary by age and sex.

Objectives: The aim of the study was to identify how age and sex impact mortality due to infective endocarditis in high-income countries.

Methods: The World Health Organization mortality database was analyzed to determine trends in mortality from infective endocarditis in the United Kingdom, Germany, France, Italy, Japan, Australia, the United States, and Canada between 2000 and 2021. Age-standardized and age-specific (≤49, 50-64, 65-79, and ≥80 years) mortality rates per 100,000 persons in either sex were calculated and compared using the male-to-female ratio. Trends were analyzed using joinpoint regression.

Results: During the most recent observation year, there were widespread differences in the age-standardized mortality rates (per 100,000) across the 8 countries (from 0.40 [95% CI: 0.38-0.42] in Japan to 1.29 [95% CI: 1.23-1.35] in France), with increasing trends in all except for Japan (decreasing trend) and the United States (constant trend). Age-standardized mortality was male-dominant in all countries (mean ratios ranging from 1.16 in Japan to 1.70 in France). The between-sex differences tended to be less pronounced with increasing age. The ratios of age-specific mortality rates between sexes remained stable or showed a progression toward male dominance across all age groups. Among those ≤49 years, mortality rates increased significantly in females in the United Kingdom, Australia, and the United States, and in both sexes in Canada.

Conclusions: Mortality rate from infective endocarditis is increasing in most countries, with varying patterns and degrees of changes observed in relation to sex and age. This underscores the crucial need to identify the root causes at the individual country level.