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)

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.