Temporal trends and disparities in US mortality with co-listed atrial fibrillation and gastrointestinal bleeding-related mortality, 1999–2020

Oral anticoagulants (OACs) effectively reduce stroke and mortality in patients with atrial fibrillation (AF), but their use increases the risk of gastrointestinal (GI) bleeding. The combined mortality burden from deaths in which AF and GI bleeding are co-listed has not been comprehensively characterized. This study evaluated national trends and demographic disparities in AF- and GI bleeding–related mortality from 1999 to 2020. Mortality data were obtained from the CDC WONDER database for U.S. residents from 1999 to 2020. Deaths were included only when both AF and GI bleeding were recorded anywhere on the death certificate as underlying or contributing causes. Crude and age-adjusted mortality rates (AAMR) per 100,000 population were calculated, and Joinpoint regression estimated annual percent changes (APC). Deaths involving AF and GI bleeding increased from 1,486 in 1999 to 4,855 in 2020. AAMR rose from 0.55 to 1.16 per 100,000, with an accelerated rise between 2010 and 2020 (APC = 5.65%, p < 0.05). Males showed higher AAMR than females (AAPC = 3.61% vs. 2.83%), and White populations had the highest rates, while American Indian/Alaska Natives had the lowest. Nonmetropolitan areas showed faster increases than metropolitan ones (AAPC = 4.20% vs. 2.88%), with the central and western regions experiencing the steepest growth. Mortality was highest among older adults. AF- and GI bleeding–related mortality more than doubled from 1999 to 2020, disproportionately affecting elderly men, rural populations, and western U.S. regions. Targeted preventive strategies are essential to mitigate these rising disparities.