The rising death burden of atrial fibrillation and flutter in low-income regions and younger populations

Ye-Mao Liu; Wenxin Wang; Xingyuan Zhang; Fang Lei; Juan-Juan Qin; Xuewei Huang; Ruyan Li; Lijin Lin; Mingming Chen; Yan-Xiao Ji; Peng Zhang; Xiao-Jing Zhang; Zhi-Gang She; Jingjing Cai; Chengsheng Xu; Zhengjun Shen; Hongliang Li

doi:10.3389/fepid.2023.1122790

The rising death burden of atrial fibrillation and flutter in low-income regions and younger populations

Front Epidemiol. 2023 Jun 5:3:1122790. doi: 10.3389/fepid.2023.1122790. eCollection 2023.

Authors

Ye-Mao Liu^#^{1

2}, Wenxin Wang^#^{2

3}, Xingyuan Zhang^#^{2

3}, Fang Lei^{2

3}, Juan-Juan Qin^{2

3}, Xuewei Huang^{2

3}, Ruyan Li⁴, Lijin Lin^{2

3}, Mingming Chen^{2

3}, Yan-Xiao Ji^{2

5}, Peng Zhang^{2

3

5}, Xiao-Jing Zhang^{2

3}, Zhi-Gang She^{2

3}, Jingjing Cai⁶, Chengsheng Xu¹, Zhengjun Shen¹, Hongliang Li^{2

3}

Affiliations

¹ Department of Cardiology, Huanggang Central Hospital, Huanggang, China.
² Institute of Model Animal, Wuhan University, Wuhan, China.
³ Department of Cardiology, Renmin Hospital of Wuhan University, School of Basic Medical Science, Wuhan University, Wuhan, China.
⁴ Northfield Mount Hermon School, Gill, MA, United States.
⁵ Medical Science Research Center, Zhongnan Hospital of Wuhan University, Wuhan, China.
⁶ Department of Cardiology, The Third Xiangya Hospital, Central South University, Changsha, China.

^# Contributed equally.

Abstract

Objective: The aim of the study was to depict the global death burden of atrial fibrillation and/or flutter (AFF) between 1990 and 2019 and predict this burden in the next decade.

Methods: We retrieved annual death data on cases and rates of AFF between 1990 and 2019 from the Global Burden of Disease (GBD) Study 2019 and projected the trends for 2020-2029 by developing the Bayesian age-period-cohort model.

Results: The global number of deaths from AFF increased from 117,038.00 in 1990 to 315,336.80 in 2019. This number is projected to reach 404,593.40 by 2029. The age-standardized mortality rates (ASMRs) of AFF have increased significantly in low- to middle-sociodemographic index (SDI) regions, which will surpass that in high SDI regions and reach above 4.60 per 100,000 by 2029. Globally, women have a higher ASMR than men, which is largely attributed to disproportionately higher mortality in women than men in lower SDI regions. Notably, AFF-related premature mortality continues to worsen worldwide. A pandemic of high systolic blood pressure and high body mass index (BMI) largely contributes to AFF-associated death. In particular, low- to middle-SDI regions and younger populations are increasingly affected by the rapidly growing current and future risk of high BMI.

Conclusion: The global death burden of AFF in low-income countries and younger generations have not been sufficiently controlled in the past and will continue growing in the future, which is largely attributed to metabolic risks, particularly for high BMI. There is an urgent need to implement effective measures to control AFF-related mortality.

Keywords: atrial fibrillation and flutter; early death; global burden of disease; metabolic risk factors; prevention.

Grants and funding

This work was supported by grants from the National Key R&D Program of China (2016YFF0101504 and 2020YFC2004702), the National Science Foundation of China (81630011, 81970364, 81970070, 81970011, 81770053, 81870171, 82170455, 82170595, 82170436, and 82000299), the Hubei Science and Technology Support Project (2019BFC582 and 2018BEC473), Henan Charity Federation Hepatobiliary Fund (GDXZ2021008), Fundamental Research Funds for Central Universities of the Wuhan University (2042020kf0051), and Medical flight plan of Wuhan University (TFJH2018006).