The influence of race in older adults with infective endocarditis

Abstract

Background: Age is a risk factor for infective endocarditis, and almost half of diagnosed patients are age ≥ 60 years. Large national studies have not evaluated inpatient mortality and surgical valvular interventions between older White and Black patients hospitalized with infective endocarditis. Methods: We used the Nationwide Inpatient Sample database to identify older adults ≥60 years in North America with a principle diagnosis of infective endocarditis. Multivariate logistic regression was used to compare in-hospital mortality and valvular repairs/replacement between older Black and White patients. Results: Of 10,390 adults, age ≥ 60 years hospitalized for infective endocarditis during 2013 and 2014, 7356 were White and 1089 Black. Blacks were younger (mean age: 70.5 ± 0.5 vs. 73.5 ± 0.2 years, p < 0.01), lived in more zip codes with a median annual income <$39,000/yr. (40.4% vs 18.8%, p < 0.01), and had higher co-morbidity burden (Charlson comorbidity score ≥ 3: 54.6% vs 40.7%, p < 0.01). After multivariate adjustment, Blacks had higher odds for in-hospital mortality (Odds Ratio (OR) = 2.0, [Confidence Interval (CI) 1.1-3.8]; p = 0.020), and lower odds for mitral valve repairs/replacements (OR = 0.53, CI: 0.29-0.99, p = 0.049). Conclusions: Blacks age ≥ 60 years hospitalized in North America with infective endocarditis are less likely to undergo mitral valvular repairs/replacement and had higher in-hospital mortality compared to White patients.

Five-Year Cardiovascular Outcomes after Infective Endocarditis in Patients with versus without Drug Use History

“…Among Black patients, ischemic stroke was significantly higher among PWUD. Previous work has acknowledged the systemic and institutional disadvantages faced by women and racial/ethnic minorities when receiving care for IE and for substance use disorders in general [ 15 , 38 ]. The recommendations of previous authors and the American Association for Thoracic Surgery, including the need to connect PWUD to addiction medicine services, with special attention to vulnerable demographic populations, are especially relevant [ 18 , 39 , 40 ].…”

“…Differences in post-IE outcomes by sex and race/ethnicity have been noted in the literature [ 15 , 16 , 17 ]. Therefore, we performed secondary analyses of outcomes in male PWUD vs. non-PWUD, female PWUD vs. non-PWUD, and among PWUD vs. non-PWUD by race.…”

Comparisons between White and Black Patients Hospitalized with Postliver Transplant Complications/Failure

“…Furthermore, highlighting racial disparities in hospital outcomes is critical to increasing awareness among hepatologists, surgeons, and the broader hospital system containing multidisciplinary care teams to address additional complex factors that may affect patient outcomes. Racial disparities during hospitalizations have been identified during hospitalizations for various medical conditions 8–10 ; however, it is unclear whether these disparities exist regarding patients hospitalized for PLTCF. Given the existing racial health disparities among patients with liver transplants in the United States, we hypothesized that during hospitalizations, Blacks with PLTCF would have higher mortality and use greater hospital resources than Whites with PLTCF.…”