Death rates from a heart inflammation condition spiked among young American adults over a two-decade period between 1999 and 2020, according to a new study that blamed this increase on the opioid crisis.
The study, published in the Journal of the American Heart Association on Dec. 13, 2023, examined mortality trends in the United States owing to infective endocarditis (IE)—an inflammation of the lining of the heart valves or chambers that can be fatal. The disease is triggered when germs, typically bacteria, from other parts of the body enter the bloodstream and attack the lining of the valves or chambers.
After analyzing mortality data sourced from the U.S. Centers for Disease Control and Prevention (CDC) between 1999 and 2020, researchers discovered there was a “marked acceleration in mortality” among the 25- to 44‐year-old age group, which it characterized as “a cause for alarm.”
The study authors speculated that “this acceleration was likely due mainly to the opioid crisis that has engulfed several states and involved principally younger adults.”
“The United States is currently in the midst of the worst opioid crisis, with at least 1 in 10 Americans using illicit drugs. IE remains one of the most dreaded complications of injection drug use.”
The opioid crisis has become so bad that some officials are calling fentanyl, a popular opioid, a national security threat. Fentanyl is an odorless and tasteless drug. Just two milligrams, equivalent to five grains of table salt, can potentially kill a human being.
The quantity of fentanyl seized by the U.S. Customs and Border Protection (CBP) last fiscal year would be enough to create over 6 billion potentially lethal doses.
Researchers discovered that the overall mortality rate owing to IE declined between 1999 and 2020.
However, for the age group of 25- to 34-year-olds, IE mortality “increased significantly” by 5.4 percent annually on average during this period. Among 35- to 44-year-olds, there was a 2.3 percent increase.
Mortality remained “stagnant” among people aged 45 to 54 years and showed a “significant decline” in people aged 55 and above.
The study noted there was a surge in deaths among 25- to 34-year-olds where IE and substance use disorder were listed as comorbidities. The death rate jumped from 0.17 per million individuals between 1999 and 2006 to 1.29 per million individuals between 2014 and 2020.
Among 35- to 44-year-olds, the death rate spiked from 0.48 per million people to 1.26 per million during this period.
“The finding of increased mortality in the 25–44 year age group is a cause for concern. These younger age groups are less likely to have significant comorbidities and hospitalizations to be at risk for hospital‐acquired bacteremia and IE and lower risk of mortality,” the authors wrote.
The study disclosed a potential conflict of interest. Author Dr. Vinay Badhwar serves as a non-remunerative consultant to health care company Abbott. No source of funding was listed.
Mortality Trends, Opioid Crisis
The Dec. 13 research revealed several links between IE deaths in terms of gender, race, and state trends. Gender-wise, IE mortality declined among both men and women but the magnitude of decrease was greater among females.
Between 1999 and 2020, IE mortality for women fell from 24.87 per million individuals to 19.59. Among men, the mortality declined from 27.61 to 25.49.
IE mortality declined for all races.
In terms of geography, large metros saw a “significant decline” in IE mortality, while small metros showed “no significant change.”
Some states exhibited a “statistically significant decrease or an increase” in mortality while the trend remained flat in others. The states that registered a “significant increase” in mortality were Kentucky, Tennessee, and West Virginia.
The researchers called for more investigation to identify the causes of IE mortality among young adults and in the three states that saw the greatest increase in deaths. Since the opioid crisis mostly involves younger adults, these populations could be at risk.
“Comprehensive care plans for those treated for infective endocarditis should also include screening and treatment for substance use disorder,” said Sudarshan Balla, lead author of the study and an associate professor of medicine at the West Virginia University Heart and Vascular Institute at J.W. Ruby Memorial Hospital in Morgantown, West Virginia.
Some states have implemented programs aimed at reducing the harms caused by substance and drug abuse. “Whether these programs make an impact is yet to be determined,” Mr. Balla said.
Over 68 percent of the 107,081 drug overdose deaths in the United States in 2022 were owing to opioids. More than 73,000 deaths were attributed to fentanyl. To put it into context, this is more than the number of Americans killed in the Vietnam War.
In September, the U.S. Department of Homeland Security unveiled steps to counter the spread of illicit opioids like fentanyl. The measures targeted enablers of opioid trafficking and proposed conducting outreach operations with private industry to limit the shipment of illegal drugs.
In early 2023, Rep. Morgan Griffith (R-Va.) introduced H.R. 467, or the “Halt All Lethal Trafficking of Fentanyl Act,” which sought to permanently classify fentanyl-related substances (FRS) as a Schedule I drug.
The Drug Enforcement Administration had placed FRS into Schedule I temporarily, a classification that will expire by the end of 2024. The bill will also reform the scheduling system to make it easier for researchers to conduct studies on controlled substances.
In May, the Biden White House announced support for the bill. The act was passed by the House of Representatives in a 289 to 133 vote that month.