Key result
Smoking linked to ~322,000 AF/AFL DALYs across G20 countries with rates remaining stable.
Why the study?
Comprehensive assessments of smoking-attributable atrial fibrillation and atrial flutter burden across G20 countries remain limited.
Observational
Effect estimate: EAPC 0.12 (95% CI -0.09-0.33)
While age-standardized rates of smoking-attributable AF/AFL in G20 countries are stable, the absolute burden is projected to rise significantly by 2050 due to population growth and aging, emphasizing the need for targeted tobacco control.
Projected smoking-attributable AF DALY rise in G20 through 2050 may support tobacco control efforts; leaves open intervention effects on incidence.
INTRODUCTION: Atrial fibrillation and atrial flutter (AF/AFL) are major contributors to the cardiovascular disease burden in G20 countries. However, comprehensive assessments of smoking-attributable AF/AFL burden across the G20 remain limited. The objective of this study was to evaluate temporal trends in the AF/AFL burden attributable to smoking in G20 countries from 1990 to 2021 and to project future trends through 2050. METHODS: This secondary analysis used data from the Global Burden of Disease (GBD) 2021 study. Smoking-attributable disability-adjusted life years (DALYs), deaths, years lived with disability (YLDs), and years of life lost (YLLs) for AF/AFL were extracted for G20 countries between 1990 and 2021. Trends were analyzed by age, sex, and country, and estimated annual percentage changes (EAPCs) were calculated. Autoregressive integrated moving average (ARIMA) and exponential smoothing (ES) models were applied to project the disease burden from 2022 to 2050. RESULTS: In 2021, smoking-attributable AF/AFL accounted for 321761.89 DALYs (95% UI: 187788.89-476327.05) in the G20. Overall age-standardized rates remained relatively stable from 1990 to 2021. Japan showed a declining trend, whereas Saudi Arabia and Indonesia exhibited increasing burdens. Males consistently experienced higher burdens than females, and the highest absolute burden occurred in individuals aged 65-89 years. Projections indicate that from 2022 to 2050, absolute numbers of deaths, YLDs, YLLs, and DALYs attributable to smoking-related AF/AFL will continue to rise, particularly among males, despite stable or slightly declining age-standardized rates. CONCLUSIONS: Although age-standardized smoking-attributable AF/AFL rates in G20 countries have remained largely stable, absolute burdens are expected to increase substantially due to population growth and ageing. Pronounced sex- and country-level heterogeneity highlights the need for sustained and targeted tobacco control and cardiovascular prevention strategies.
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Yang et al. (2026) conducted an observational in Atrial fibrillation and atrial flutter (AF/AFL). Smoking vs. Non-smoking was evaluated on Smoking-attributable disability-adjusted life years (DALYs) for AF/AFL (EAPC 0.12, 95% CI -0.09-0.33). In 2021, smoking-attributable atrial fibrillation and atrial flutter accounted for 321,761.89 DALYs in G20 countries, with age-standardized rates remaining relatively stable from 1990 to 2021.
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