Key result
High BMI-attributable global AF mortality and disability rates increased ~67% between 1990 and 2021.
Why the study?
Sex- and region-specific temporal trends in obesity-attributable AF and AFL over the past three decades needed assessment to inform prevention and management strategies.
Observational
The global burden of AF/AFL attributable to high BMI has increased significantly from 1990 to 2021, with a notable shift towards a higher burden in men and lower-SDI regions over time.
Sex- and region-specific obesity-attributable AF/AFL trends inform targeted prevention planning; leaves open causal confirmation and intervention trials.
AIMS: This study leveraged the Global Burden of Disease (GBD) database to assess sex- and region-specific trends in obesity-attributable atrial fibrillation and atrial flutter (AF/AFL) over the past three decades. We aimed to unravel temporal dynamics to inform evidence-based prevention and clinical management strategies. METHODS: Using 2021 GBD data, we evaluated the AF/AFL burden attributable to high body mass index (HBMI). Our analysis included deaths, age-standardized rates (ASR), disability-adjusted life years (DALYs), and estimated annual percentage changes (EAPC), stratified by age group, gender, Sociodemographic Index (SDI), and region. We also assessed health inequalities using the Gini coefficient and conducted hypothesis testing to examine relationships between mortality, disability rates, and gender from 1990 to 2021. RESULTS: In 2021, HBMI-related AF/AFL caused 27,236 deaths and 724,573 DALYs globally. These figures represent increases of 66.7% and 272.5%, respectively, compared to 1990. The age-standardized mortality rate (ASMR) and DALY rate rose by 66.7% and 67.8%. Nearly half of the disease burden occurred in high and upper-middle SDI regions; however, other SDI regions are experiencing a rapid increase in burden. Notably, elderly women aged 65 + bore the highest disease burden. The Gini index for DALY rates declined from 0.45 in 1990 to 0.35 in 2020, indicating reduced health inequality. While women had a higher overall burden, men exhibited faster growth in mortality and disability rates. Over the past 30 years, the EAPC for DALYs and mortality in men was 1.76 and 1.85 times higher, respectively, than in women. Critically, in high-SDI regions, men’s absolute disability burden and rates have surpassed women’s across all age groups. CONCLUSION: Disparities in the HBMI-attributable AF/AFL burden (HAB) across sociodemographic strata have narrowed significantly over the past three decades, reflecting progressive mitigation of structural health inequities. Economic advancement propagates the HAB across the development spectrum, and temporal analysis confirms this trajectory. The current burden profile observed in high-SDI regions suggests the future epidemiological path for lower-SDI settings. GBD projections indicate an impending reversal of the AF/AFL burden sex differential. Accelerating male-predominant obesity trends are poised to drive disproportionate burden escalation in coming decades. Targeted screening and early therapeutic intervention in young obese cohorts may mitigate future burden escalation among aging populations.
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Xu et al. (2025) conducted an observational in Atrial fibrillation and flutter (AF/AFL). High body mass index (HBMI) vs. 1990 baseline was evaluated on Age-standardized mortality and DALY rates. Between 1990 and 2021, the global age-standardized mortality and disability-adjusted life year rates for atrial fibrillation and flutter attributable to high body mass index increased by 66.7% and 67.8%, respectively.
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