Global, regional, and national burden of atrial fibrillation/flutter attributable to metabolic, behavioral, and environmental risk factors, 1990-2021: a longitudinal observational study.
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Abstract
Background: Atrial fibrillation/flutter (AF/AFL) remains a significant global public health issue, with its development influenced by metabolic, behavioral, and environmental risk factors However, comprehensive analyses of temporal and geographic variations in AF/AFL burden attributed to risk factors remain lacking.
Objective: This study reveals the geographic and temporal distribution of the burden of AF/AFL attributable to specific risk factors at global, regional, and national levels from 1990 to 2021, providing a scientific basis for developing targeted prevention and control policies.
Methods: We extracted data on AF/AFL risk-attributable deaths, disability-adjusted life years (DALYs), age-standardized mortality rates (ASMRs), and age-standardized DALY rates (ASDRs) from the Global Burden of Disease (GBD) database for the years 1990 to 2021. The burden of AF/AFL caused by metabolic, behavioral, and environmental risk factors stratified by age, sex, region, and country. Long-term trends in the AF/AFL burden associated with specific risk factors were assessed using the average annual percentage change (AAPC).
Results: Over the past 32 years, high body mass index has been the primary contributor to the rising AF/AFL burden, with AAPCs of ASMR and ASDR at 1.66 (95% CI: 1.63-1.68) and 1.68 (95% CI: 1.67-1.70), respectively. The most significant increase occurred in males aged 30-34. The burden related to high sodium diets and lead exposure is also rising, particularly in females aged 65-69. Smoking showed the greatest decrease, with AAPCs of ASMR and ASDR at -0.66 (95% CI: -0.68 to -0.65) and -0.72 (95% CI: -0.72 to -0.71), most significantly in women aged 30-34. High systolic blood pressure decreased overall, but increased in individuals aged 34-49. East Asia saw the largest increase in burden from high body mass index, with AAPCs of ASMR at 8.28 (95% CI: 8.18-8.37) and ASDR at 8.22 (95% CI: 8.18-8.26). In 2021, China had the highest AF/AFL deaths and DALYs attributed to high systolic blood pressure, high sodium diets, smoking, and lead exposure.
Conclusion: From 1990 to 2021, high body mass index became the primary driver of the rising global AF/AFL burden, particularly affecting East Asia and young and middle-aged adults. In contrast, the burden associated with smoking showed the greatest decline. In 2021, China had the highest AF/AFL burden due to various risk factors. Given the regional variations and characteristics of high-risk populations, policymakers should develop targeted yet comprehensive prevention strategies. These measures should include promoting healthy dietary habits, strengthening global surveillance systems, and fostering data-sharing collaborations to mitigate this growing epidemic.
期刊介绍：
No subject pertains more to human life than nutrition. The aim of Frontiers in Nutrition is to integrate major scientific disciplines in this vast field in order to address the most relevant and pertinent questions and developments. Our ambition is to create an integrated podium based on original research, clinical trials, and contemporary reviews to build a reputable knowledge forum in the domains of human health, dietary behaviors, agronomy & 21st century food science. Through the recognized open-access Frontiers platform we welcome manuscripts to our dedicated sections relating to different areas in the field of nutrition with a focus on human health.
Specialty sections in Frontiers in Nutrition include, for example, Clinical Nutrition, Nutrition & Sustainable Diets, Nutrition and Food Science Technology, Nutrition Methodology, Sport & Exercise Nutrition, Food Chemistry, and Nutritional Immunology. Based on the publication of rigorous scientific research, we thrive to achieve a visible impact on the global nutrition agenda addressing the grand challenges of our time, including obesity, malnutrition, hunger, food waste, sustainability and consumer health.
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