Date of Award

January 2023

Document Type


Degree Name

Master of Public Health (MPH)


School of Public Health

First Advisor

Gail D'Onofrio


AbstractIntroduction: The opioid epidemic continues to be a public health concern in the United States. Increase in non-oral injection opioid use calls attention to injection drug use related complications such as endocarditis, a microbial infection to the heart and intracardiac parts associated with high morbidity and mortality. Scarce amount of up-to-date analysis has been conducted in New York City (NYC) to look at this health burden. This study investigated the burden of endocarditis hospitalization and its relationship with opioid use in hospitalized adults in NYC from 2001-2019. Methods: A longitudinal study was conducted utilizing the Statewide Planning and Research Cooperative System (SPARCS) hospital discharge data system for trend analysis and risk analysis of endocarditis hospitalization in NYC, using Poisson regression and log-binomial regression, for residents with aged ≥18 years from 2001 to 2019. Study controlled for age, sex, race/ethnicity, borough, poverty level, and other co-morbid conditions. Results: A total of 34,997 endocarditis hospitalizations were recorded in NYC from 2001 to 2019, of which 3,660 (10%) had record of opioid use. Compared to non-opioid users, opioid users had 1.85 [95% CI: 1.77-1.93] times the risk of being hospitalized for endocarditis. Almost all categories of opioid users, stratified by age, sex, race/ethnicity, borough, poverty level, and other co-morbid conditions, had higher risk of being hospitalized for endocarditis as compared to their non-opioid user counterparts. Trend analysis showed that crude rate of endocarditis hospitalization among opioid users significantly increased from 2015 to 2019 (p≤0.0001). Conclusion: Opioid use is a risk factor for endocarditis hospitalization in NYC for all groups of people. Future investigation, such as on how syringe exchange programs help protect injection users from endocarditis might be investigated. Key Words: Endocarditis, opioid use, risk analysis, tend analysis, chronic disease epidemiology


This thesis is restricted to Yale network users only. It will be made publicly available on 05/22/2028