Differences in global, regional, and national time trends in disability-adjusted life years for atrial fibrillation and flutter, 1990-2019: an age-period-cohort analysis of the 2019 Global Burden of Disease Study (Preprint)

• DOI: 10.2196/preprints.51597
• Publication Date: 2023-08-07T09:46:05Z
• Authors: Shengxian Peng; Guigang Qiu; Qingwei Zhang; Weike Hu; Min Hao; Yue Liu; Mengyan Sun; Niying Yin; Wenzhai Cao; Xiaozhu Liu

BACKGROUND The Global Burden of Disease, Injury, and Risk Factor Study 2019 (GBD 2019) utilized data to examine the burden and variations in the disability-adjusted life years (DALYs) associated with atrial fibrillation and flutter (AF/AFL) in 204 countries and territories from 1990 to 2019.

OBJECTIVE this study aims to perform a systematic and comprehensive analysis of the disease burden of AF/AFL based on the latest GBD 2019 estimates and age-period-cohort models and to differentiate the relative contributions of age, period, and cohort effects on DALYs. The analysis will cover global, regional, and national levels, examining changes in AF/AFL DALYs in 204 countries and territories from 1990 to 2019 and assessing their occurrence trends.

METHODS GBD 2019 provided AF/AFL data. An age-period-cohort model estimated net drifts and local drifts in DALYs from 30 to 34 years up to 95+ years. We also examined 1990–2019 period and cohort relative risks, to determine period and cohort effects. To quantify the temporal trends in AF/AFL DALYs age-standardised rate (ASR), average annual percentage changes (AAPCs) by age, gender, Socio-demographic Index (SDI), and location were determined. This method lets us examine the effects of age, period, and cohort on DALYs trends, perhaps revealing AF/AFL treatment gaps.

RESULTS Globally, there were 8,393,635 (95% uncertainty interval [UI]: 6,693,987 to 10,541,461) DALYs cases, an increase of 121.6% (95% UI: 111.5 to 132.0) from 1990. Between 1990 and 2019, the global DALYs ASR declined by 2.61% (95% UI -6.9 to 1.3), but the remaining SDI quintile increased except for High SDI and high-Middle SDI. Over the past 30 years, High-income Asia Pacific countries experienced the greatest decrease in DALYs ASR, whereas the largest increase was observed in Central Asia (net drift of -0.9% [95% CI: -1.0 to -0.9] and 0.6% [95% CI: 0.5 to 0.7], respectively). Almost half of the AF/AFL burden shifted from high and high-middle SDI regions to lower SDI regions. The AAPC and the SDI were shown to be inversely related. Furthermore, males and the elderly tended to carry a higher AF/AFL DALYs burden.

CONCLUSIONS The results of this study indicate that the global burden of AF/AFL is still substantial and rising, with the burden varying by SDI. These results provide exhaustive and comparable estimates that may inform global efforts to achieve equitable AF/AFL control.