{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T01:32:12Z","timestamp":1760059932815,"version":"build-2065373602"},"reference-count":40,"publisher":"MDPI AG","issue":"14","license":[{"start":{"date-parts":[[2025,7,18]],"date-time":"2025-07-18T00:00:00Z","timestamp":1752796800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>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\u20137.76) in 1999 to 3.99 (95% CI: 3.74\u20134.23) in 2019, with an APC of \u22122.59 (95% CI: \u22122.97 to \u22122.24). From 2019 to 2021, the AAMR increased by 46.62% to 5.85 (95% CI: 5.56\u20136.14) by 2021 (2019\u20132021 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.<\/jats:p>","DOI":"10.3390\/jcm14145116","type":"journal-article","created":{"date-parts":[[2025,7,18]],"date-time":"2025-07-18T11:12:34Z","timestamp":1752837154000},"page":"5116","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Declining Myocarditis Mortality in the United States and the Impact of the COVID-19 Pandemic"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5145-8626","authenticated-orcid":false,"given":"Ali Bin","family":"Abdul Jabbar","sequence":"first","affiliation":[{"name":"Department of Medicine, Division of Internal Medicine, Creighton University School of Medicine, 7710 Mercy Road, Suite 301, Omaha, NE 68124-2368, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9027-570X","authenticated-orcid":false,"given":"Daniyal Ali","family":"Khan","sequence":"additional","affiliation":[{"name":"Aga Khan University Medical College, Karachi 74800, Pakistan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"John","family":"Osborne","sequence":"additional","affiliation":[{"name":"Department of Medicine, Division of Internal Medicine, Creighton University School of Medicine, 7710 Mercy Road, Suite 301, Omaha, NE 68124-2368, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"William","family":"Thomson","sequence":"additional","affiliation":[{"name":"Department of Medicine, Division of Internal Medicine, Creighton University School of Medicine, 7710 Mercy Road, Suite 301, Omaha, NE 68124-2368, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4394-1284","authenticated-orcid":false,"given":"Ameya","family":"Chinawalkar","sequence":"additional","affiliation":[{"name":"Department of Medicine, Division of Internal Medicine, Creighton University School of Medicine, 7710 Mercy Road, Suite 301, Omaha, NE 68124-2368, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-1138-6179","authenticated-orcid":false,"given":"Mason","family":"Klisares","sequence":"additional","affiliation":[{"name":"Department of Medicine, Division of Internal Medicine, Creighton University School of Medicine, 7710 Mercy Road, Suite 301, Omaha, NE 68124-2368, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kyle","family":"Gilkeson","sequence":"additional","affiliation":[{"name":"Department of Medicine, Division of Internal Medicine, Creighton University School of Medicine, 7710 Mercy Road, Suite 301, Omaha, NE 68124-2368, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ahmed","family":"Aboeata","sequence":"additional","affiliation":[{"name":"Department of Medicine, Division of Cardiovascular Diseases, Creighton University School of Medicine, Omaha, NE 68124-2368, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,7,18]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1488","DOI":"10.1056\/NEJMra2114478","article-title":"Myocarditis","volume":"387","year":"2022","journal-title":"N. 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