Objective:
To assess differences in mortality trends from atrial fibrillation (AF) among different races and genders in the United States (US).
Background:
AF is the most common sustained cardiac arrythmia in the US. No up to date analysis has assessed AF mortality trends by race and gender across the US.
Methods:
For this observational analysis US AF mortality data from 1999 to 2018 for individuals >45 years of age were extracted from the CDC WONDER database. International Classification of Diseases code I48 was used to define AF. Mortality data were age-standardized to the US 2000 standard population, and stratified by gender and race (Caucasian, Black, Asian). Joinpoint regression analysis was used to assess for significant changes in trends over the observation period, and provide estimated annual percentage changes (EAPC)s with 95% confidence intervals (CIs).
Results:
From 1999 to 2018, the mortality rate per 100,000 population, increased significantly from 3.7 to 8.3 (+124%, the greatest increase observed) amongst Asian men (AM), from 5.4 to 10.8 (+100%) amongst Black men (BM), and from 9.2 to 19.2 (+108%) amongst Caucasian men (CM). Mortality increases, per 100,000 population, were seen from 4.0 to 7.4 (+85%, the smallest increase observed) in Asian women (AW), 5.3 to 12.8 (+121%) in Black women (BW), and 8.9 to 19.7 (+121%) in Caucasian women (CW) over the same time period. Joinpoint analysis demonstrated significant increasing AF mortality trends for both genders and all races studied. AW had the highest EAPC of 8.6 (95% CI 6.0-11.3) between 1999-2008, which slowed to 2.2 (95% CI 0.1-4.3) between 2009-2018. AM followed a similar EAPC pattern: 7.7 (95% CI 5.7-9.8) between 1999-2008, decreasing to 0.5 (95% CI -1.1-2.2) between 2009-2018. Between 1999-2018, EAPCs increased for BW (3.8, 95% CI 3.2-4.4), CW (4.4, 95% CI 4.0-4.8), BM (4.0, 95% CI 3.4-4.6) and CM (4.8, 95% CI 4.4-5.2).
Conclusion:
Between 1999 and 2018, there are increasing AF mortality trends amongst both genders and all races, with Caucasians having the greatest overall increases during the observation period. EAPCs demonstrate that the rates of increases in AF mortality are greatest in Caucasians, followed by Asian then Black Americans.