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Disclosures: The authors report no relevant financial disclosures.
September 27, 2020
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More than 250K expected to die from infective endocarditis by 2030

Source/Disclosures
Disclosures: The authors report no relevant financial disclosures.
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Based on modeling, researchers estimated that more than 250,000 people will die from infective endocarditis by 2030, with a large number of deaths occurring among people who inject drugs.

“Serious bacterial infections such as infective endocarditis (IE) are among the most common medical complications in persons who inject drugs. As drug use in the U.S. has shifted from oral ingestion to injection, the incidence of endocarditis has also skyrocketed,” Joshua A. Barocas, MD, assistant professor of medicine at Boston University School of Medicine and Boston Medical Center, told Healio. “This has caused substantial increases in morbidity, mortality, and healthcare costs.”

Barocas said the risk for endocarditis “can be mitigated with access to harm reduction services and by helping individuals reduce their injection drug use. From my own clinical experience, it became clear that we are likely to see this epidemic worsen without proper resource allocation and service planning.”

Barocas and colleagues developed a microsimulation model of the natural history of injection opioid use. According to the study, they accounted for competing risks for death and populated the model with primary and published data. Barocas and colleagues modeled cohorts of 1 million individuals with different injection behavior profiles through age 60 years and combined model-generated estimates with published data to project the total expected IE deaths in the U.S. by 2030.

Overall, the model predicted that the 10-year mortality rate for IE among individuals who inject opioids will be 20% ⎼⎼ meaning that one in five of those individuals will die from this infection. The study also estimated that at least 257,800 people are expected to die from IE by 2030.

Barocas and colleagues said people who reuse needles and do not clean skin before injecting are 10 to 30 times more likely to die from endocarditis than those who do not reuse needles and clean their skin before injecting. Those who reuse needles and do not clean their skin are up to nine times more likely to die from endocarditis than from overdose.

“Our study shows the importance of adopting a harm reduction approach for clinicians and public health professionals who wish to reduce death among persons who inject drugs,” Barocas said. “In some cases, this means that the highest priority intervention might be to address their injection technique to include skin cleaning and use of sterile equipment, even before addressing drug use itself. These simple interventions could reduce an individual’s risk of drug-use related mortality by more than 90%.”