Abstract P272: Spatial and Temporal Trends of Infective Endocarditis Hospitalizations in Kentucky, 2008-2018

Abstract

Background: Infective endocarditis (IE) hospitalization rates have increased significantly in the last decade, primarily due to the opioid abuse epidemic. A North Carolina study showed an increase in intravenous drug use infective endocarditis (IDU-IE) from 0.9 to 10.9/100,000 during 2007-2017. In 2016, Kentucky ranked among the top ten states with the highest opioid-related overdose deaths. Limited data about IE trends are available for Kentucky. Objective: To examine county-level spatial and temporal trends in IE rates in Kentucky and identify significant high-rate clusters. Methods: We used the Kentucky hospital inpatient discharge data (2008-2018). We included hospitalizations for patients 18 years and older who are Kentucky residents. All IE admissions were identified using ICD-9 and ICD-10 diagnosis codes (421.0, 421.1, 421.9, 424.90, 424.91, 424.99, 112.81, I33.0, I39, I33.9, I38, A3282, and B376). IDU-IE were identified using additional ICD codes for injected illicit drug use. We used US Census data to calculate yearly hospitalization rates of IE /100,000 residents. Joinpoint regression was used to calculate annual percent change (APC). We conducted spatiotemporal cluster analysis at the county level using a Poisson model in SaTScan. Results: Throughout the study period, there were 17,787 IE hospital admissions, including 3,577 IDU-IE. Medicaid patients were more often in the IDU-IE group rather than the non-IDU-IE (71% versus 15%). The IDU-IE hospitalization rate increased from 1.2 to 27.3 / 100,000 in 2008 to 2018 (Figure). From 2013 to 2018, APC for IDU-IE hospitalizations was 71.3, (95% CI: 47.8, 98.5). The spatiotemporal scan statistics identified five statistically significant clusters. The largest cluster occurred during 2015-2018 and included 34 counties out of 120 Kentucky counties, all located in the Appalachian region of Eastern Kentucky (RR= 2.1, p<0.00001). Conclusion: Our study showed increased rates of IE hospitalizations due to an increase in IDU-IE, especially in Eastern Kentucky.