Temporal trends and disparities in mortality involving diabetes mellitus and infective endocarditis among us adults aged 45 years or older, 1999–2024

Background National trends in mortality involving diabetes mellitus (DM) and infective endocarditis (IE) co-recorded on the same death certificate in the United States (US) remain incompletely characterized. We examined temporal patterns and demographic and geographic differences among US adults aged ≥ 45 years. Methods We conducted a population-based ecological time-trend study using the Centers for Disease Control and Prevention Wide-ranging Online Data for Epidemiologic Research (CDC WONDER) multiple-cause-of-death data for 1999–2024. Deaths among US adults aged ≥ 45 years were included when DM (International Classification of Diseases, Tenth Revision [ICD-10] codes E10–E14) and IE (ICD-10 codes B37.6, I33.0, I33.9, or I38) were co-recorded on the same death certificate. Age-adjusted mortality rates (AAMRs) per 100,000 persons in the general US population aged ≥ 45 years and age-specific crude rates were analyzed using Joinpoint regression. Race- and ethnicity-specific trends were analyzed for 1999–2020, whereas 2021–2024 estimates were presented descriptively. Sensitivity analyses reduced the maximum number of joinpoints from four to three, excluded the 2020 and 2021 observations, and restricted the analysis to the 1999–2020 bridged-race database period. Results We identified 41,455 deaths. Annual deaths increased from 1,208 in 1999 to 2,400 in 2024, while the AAMR increased from 1.27 to 1.56 per 100,000. The AAMR declined during 2003–2016 (APC, − 1.94%; P < 0.0001) and increased during 2016–2024 (APC, 4.56%; P < 0.0001), with a full-period AAPC of 0.98% (95% CI, 0.13–1.83; P = 0.0234). The AAPC was significant among men (1.76%; 95% CI, 0.19–3.36) but not women (− 0.04%; 95% CI, − 0.67 to 0.59). Adults aged ≥ 85 years showed a significant full-period increase (AAPC, 2.46%; 95% CI, 1.03–3.92). Regional and urban–rural variation was observed; pooled state-level AAMRs varied within each database period. The recent increase persisted in model-complexity and COVID-period sensitivity analyses; in 1999–2020, the final segment remained significantly increasing although the full-period AAPC was nonsignificant. Conclusions The AAMR for deaths with co-recorded DM and IE increased from the mid-2010s onward and varied across demographic and geographic groups. These findings support continued population-level surveillance but do not establish individual-level causality or prognosis.