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Socioeconomic disparities in long-term mortality after infective endocarditis in Denmark: a nationwide cohort study

Year: 2025

Type: article

Abstract: Background Socioeconomic position (SEP) influences several determinants of infective endocarditis (IE) progression. Whether IE mortality differs by SEP remains unclear. We examined 5-year mortality after IE by individual-level SEP. Methods Using nationwide Danish registries, we identified patients with first-time IE (2010–2022). SEP was assessed by educational and affluence level, categorised as low, medium, and high. The Kaplan–Meier estimator provided 30-day, 1-, 3-, and 5-year mortality risks, risk differences, and risk ratios. Time-varying hazard ratios were derived from flexible parametric models. We estimated attendance at outpatient and dental follow-up visits (indicating adherence to follow-up) using the Aalen-Johansen estimator and modelled hospitalisation rate during follow-up (indicating comorbid disease burden) using a joint frailty model, treating death as a competing event in all models. Findings The 5-year mortality by educational level was 63.1% (95% CI: 60.8%–65.2%) for low, 53.1% (95% CI: 51.3%–54.9%) for medium, and 45.8% (95% CI: 42.5%–48.8%) for high education. The excess mortality was particularly pronounced within the first 2 years. Within one year after discharge, 65.2% (95% CI: 62.9%–67.4%) of low, 73.6% (95% CI: 72.0%–75.2%) of medium, and 74.5% (95% CI: 71.8%–77.2%) of high-education patients had an outpatient contact. The corresponding five year dental visit proportions were 44.0% (95% CI: 41.6%–46.5%), 64.0% (95% CI: 62.2%–65.9%), and 74.0% (95% CI: 71.2%–76.9%), respectively. The hazard ratio for hospitalisations was 1.35 (95% CI: 1.25–1.49) when comparing low vs. high education and 1.19 (95% CI: 1.10–1.27) for low vs. medium. Estimates and time-dependent patterns were similar for affluence level. Interpretation Patients with low SEP had higher IE mortality, particularly within the first 2 years. Reduced adherence to follow-up care and comorbid diseases may contribute to this. Determining how the excess mortality is directly linked to the IE episode warrants further investigation. Funding Independent Research Fund Denmark (grant no. 3101-00102B) and Center for Population Medicine, Department of Clinical Epidemiology, Aarhus University.

Source: The Lancet Regional Health - Europe

DOI: 10.1016/j.lanepe.2025.101568

Authors: Søren K. Martiny, Morten Schmidt, Jonas A. Povlsen, Kirstine K. Søgaard, Hans E. Bøtker, Henrik T. Sørensen

Institutions: Aarhus University, Aarhus University Hospital, Regionshospitalet Herning, Aalborg University Hospital

Language: English

Topic: Infective Endocarditis Diagnosis and Management

Subfield: Epidemiology

Field: Medicine

Domain: Health Sciences

SDGs: Good health and well-being, Reduced inequalities

Open Access status: gold

Estimated APC paid: $4,930