Publication date: Jul 18, 2025
Background: Myocarditis is associated with increased mortality due to complications such as cardiogenic shock and arrhythmia. Trends of myocarditis-related mortality in the United States, along with demographic and regional disparities and changes during the COVID-19 pandemic, are unknown. Methods: We used the Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research (CDC WONDER) database to extract data for myocarditis deaths from 1999 to 2023. The Joinpoint Regression Program was used to analyze long-term trends in mortality, and R Studio (version 4. 4.1) was used to calculate expected and excess mortality for 2020 to 2023. Results: There were 33,016 myocarditis-related deaths from 1999 to 2023. The age-adjusted mortality rate (AAMR) of myocarditis deaths decreased by 46. 08% from 7. 40 (95% CI: 7. 04-7. 76) in 1999 to 3. 99 (95% CI: 3. 74-4. 23) in 2019, with an APC of -2. 59 (95% CI: -2. 97 to -2. 24). From 2019 to 2021, the AAMR increased by 46. 62% to 5. 85 (95% CI: 5. 56-6. 14) by 2021 (2019-2021 APC 22. 3%*), reversing the gains of the previous two decades. By 2023, the AAMR recovered to 4. 33 (95% CI: 4. 09 to 4. 58), though mortality was still higher than expected from pre-pandemic trends. From 2020 to 2023, there were 40. 12% more deaths than expected, with 54. 94% higher mortality in 2021. Briefly, 70. 33% of excess myocarditis-related deaths also had COVID-19, with a peak of 76. 15% of excess myocarditis deaths in 2021 being reported as involving COVID-19 infection. Significant disparities in mortality trends persisted, with males, NH Black or African Americans, and the elderly having higher mortality rates. Conclusions: Myocarditis mortality decreased in the United States from 1999 to 2019 but significantly increased during the COVID-19 pandemic years 2020 and 2021. At the height of the pandemic, COVID-19 infection contributed to almost three-quarters of excess myocarditis mortality. Significant disparities in myocarditis mortality persisted from 1999 to 2023.
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| Concepts | Keywords |
|---|---|
| African | COVID-19 pandemic |
| Covid | disparities |
| Elderly | mortality |
| Myocarditis | myocarditis |
| trends | |
| United States |