Mortality trends and disparities in older U.S. adults with atrial fibrillation and COPD: a 1999–2020 CDC WONDER analysis with forecast to 2030

Background: Atrial fibrillation (AF) is prevalent in elderly individuals with comorbidities, particularly those with chronic obstructive pulmonary disease (COPD), where their coexistence increases mortality risk. This study examines mortality trends and disparities among U.S. adults aged 65 and older affected by both AF and COPD from 1999 to 2020. Methods: We analyzed CDC WONDER mortality records for deaths with both AF and COPD listed on the death certificate. Age-adjusted mortality rates (AAMRs) were assessed, and temporal trends were evaluated using annual and average annual percent changes (APC/AAPC) via Joinpoint regression. An ARIMA model was used to project mortality rates through 2030. Results: A total of 399,413 deaths were recorded. The AAMR increased from 27.39 in 1999 to 65.29 in 2020, reflecting an AAPC of 4.21 (95% CI: 3.75-4.68). Men had a higher AAMR (57.01) than women (34.96). Non-Hispanic White individuals had an AAMR 2.8 times higher than Hispanics. Non-metropolitan areas had a higher AAMR than metropolitan areas. The leading causes of death were COPD, ischemic heart disease, and cancer, with the most common place of death shifting from medical facilities to home by 2020. Projections suggest the AAMR will reach 92.62 by 2030, with the highest increase observed in individuals aged ≥85. Conclusion: Mortality involving coexisting AF and COPD in older adults has increased over the past two decades, with disparities across sex, race, and geography. Projections indicate continued mortality increases, emphasizing the need for targeted interventions in high-risk populations.