Endocarditis, Drug Use and Biological Sex: A Statewide Analysis Comparing Sex Differences in Drug Use-Associated Infective Endocarditis With Other Drug-Related Harms
Authors: L. Madeline McCrary, Mary E. Cox, Kate E. Roberts, Andrea K. Knittel, Robyn A. Jordan, Scott K. Proescholdbell, Asher J. Schranz
Source: International Journal of Drug Policy, Volume123, January 2024, DOI10.1016/j.drugpo.2023.104280
Publication Type: Journal Article
Abstract: Objectives: Hospitalizations for drug use-associated infective endocarditis (DUA-IE) have risen sharply across the United States over the past decade. The sex composition of DUA-IE remains less clear, and studies have indicated a possible shift to more females. We aimed to compare more recent statewide hospitalization rates for DUA-IE in females versus males and contextualize them among other drug-related harms in North Carolina (NC).Methods: This study was a retrospective analysis using public health datasets of all NC hospital discharges for infective endocarditis from 2016 to 2020. Drug use-related hospitalizations were identified using ICD-10-CM codes. Discharge rates by year and sex for DUA-IE and non-DUA-IE were calculated and compared to fatal overdoses and acute hepatitis C (HCV). Temporal, demographic, and pregnancy trends were also assessed.Results: Hospitalizations rates for DUA-IE were 9.7 per 100,000 over the five-year period, and 1.2 times higher among females than males. Females composed 57% of DUA-IE hospitalizations over the period. Conversely, fatal overdose, acute HCV, and non-DUA-IE hospitalization rates were higher among males. Age, county of residence, and pregnancy status did not explain the higher DUA-IE among females.Conclusion: Females now comprise the majority of DUA-IE hospitalizations in NC, unlike other drug-related harms. No clear demographic or geographic associations were found, and further research is needed to explain this phenomenon. Preventing invasive infections among females who inject drugs should be prioritized.
