Regional and sex differences in infective endocarditis mortality in Spain

INTRODUCTION: This study aimed to describe national and regional trends in infective endocarditis (IE) mortality in Spain. METHODS: This ecological study analyzed IE mortality trends in Spain from 1999 to 2023 using data from the Spanish National Institute of Statistics. Age-standardized mortality rates (ASMRs) were calculated using direct standardization to the 2013 European Standard Population. Joinpoint regression analysis identified significant shifts in trend trajectories, calculating Annual Percentage Change (APC) and Average Annual Percent Change (AAPC). Regional disparities were assessed using Standardized Mortality Ratios (SMRs) for 2023. RESULTS: Between 1999 and 2023, 29,766 IE deaths occurred in Spain; 58.0% were women, and 89.0% were aged ≥65 years. Men's ASMR increased from 2.46 to 2.95 per 100,000 (AAPC: +1.2%), showing significant rise from 1999 to 2010 (APC: +2.1%) followed by stabilization. Conversely, women's ASMR declined from 2.60 to 2.00 per 100,000 (AAPC: -0.5%), with initial increase (1999-2017, APC: +0.9%) followed by marked decline (2017-2023, APC: -4.9%). Regional variations were notable. Among men, Galicia (AAPC: +3.7%) and Asturias (+3.4%) showed steepest increases, while Castile and León declined (-3.0%). In 2023, Navarre (SMR: 2.01) and Galicia (SMR: 1.93) had nearly double national IE mortality risk. For women, Galicia had most pronounced increase (AAPC: 4.1%), while significant declines occurred in Castile and León (AAPC: -4.1%). In 2023, Navarre (SMR: 2.46) and Galicia (SMR: 2.00) exhibited significantly elevated mortality. CONCLUSIONS: IE mortality in Spain exhibits complex sex-specific trends and persistent regional disparities, underscoring the need for targeted, equitable public health interventions.