Trends in atrial fibrillation and non-alcoholic fatty liver disease-related mortality in the United States from 1999 to 2020: a CDC WONDER analysis

Non-alcoholic fatty liver disease (NAFLD) is rising rapidly in the United States and is linked to atrial fibrillation (AF). Together, these conditions amplify cardiovascular risk, yet national mortality trends in AF with NAFLD remain underexplored. This study aimed to evaluate trends and regional variations in mortality related to AF and NAFLD among older adults ≥ 45 years in the United States. Death certificates from the Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research (CDC WONDER) database were analyzed for the years 1999–2020. Age-adjusted mortality rates (AAMRs) per 1 000 000 population and the annual percent change (APC) were calculated using Joinpoint regression analysis to assess national mortality trends. From 1999 to 2020, 23 294 U.S. deaths were attributed to AF and NAFLD (AAMR 9.03; 95% CI: 8.91–9.15). Mortality rose steadily, with APC increasing from + 2.92 (1999–2007) to + 15.9% (2016–2020). Male AAMRs nearly doubled (15.66–28.1), while female APC surged to 21.27 by 2020. Rates were highest in adults ≥85 years, NH American Indian (14.15), the West (9.84), and non-metropolitan areas (9.54). State disparities were striking, ranging from Rhode Island (14.35) to Montana (5.20). Mortality related to AF and NAFLD in the United States increased from 1999 to 2020, with evident disparity across demographic groups and geographical areas. This signals an urgent need for more effective public health interventions targeting the populations at most significant risk to mitigate mortality trends.