Key result
Tobacco exposure accounted for 10,012 deaths and 396,210 DALYs from atrial fibrillation and flutter globally in 2021, with absolute deaths increasing by 109.9% since 1990 despite a 19.1% decline in age-standardized mortality.
Why the study?
Tobacco use is a key modifiable risk factor for AF/AFL, motivating an assessment of global, regional, and national burdens attributable to smoking and projections of future trends.
What is the global, regional, and national burden of atrial fibrillation and flutter attributable to tobacco use from 1990 to 2021, and what are the projected trends to 2045?
Observational
What is the global, regional, and national burden of atrial fibrillation and flutter attributable to tobacco use from 1990 to 2021, and what are the projected trends to 2045?
Effect estimate: -19.11% change (95% CI -29.39 to -7.3)
Although age-standardized rates of tobacco-induced atrial fibrillation and flutter have declined, the absolute global burden continues to rise due to aging and population growth, highlighting the need for targeted tobacco control.
INTRODUCTION: Tobacco use is a key modifiable risk factor for atrial fibrillation/flutter (AF/AFL). We assessed global, regional, and national burdens attributable to smoking from 1990 to 2021 and projected future trends. METHODS: Data on deaths and DALYs were extracted from the GBD 2021 study. Main statistical analyses included the calculation of ASMR and ASDR. Trends were quantified using the estimated annual percentage change (EAPC). An age-period-cohort (APC) model was employed to decompose the effects of age, period, and birth cohort. Furthermore, a Bayesian age-period-cohort (BAPC) model was utilized to project the disease burden through 2045. RESULTS: In 2021, AF/AFL related to tobacco caused around 396000 cases, more than 10000 deaths, and 400000 disability-adjusted life years (DALYs). Compared with 1990, absolute cases and DALYs increased, while ASDR and ASR DALY declined (20%). High SDI regions improved most; low SDI regions lagged. Men and older adults bore disproportionate burdens. By 2045, deaths are projected to reach 14500 and 4200, respectively. Despite rising absolute DALYs, ASMR and ASDR are expected to decline in both sexes. CONCLUSIONS: Although standardized rates declined, the absolute burden of tobacco-related AF/AFL continues to rise, highlighting the urgent need for stronger tobacco control and targeted interventions in vulnerable populations.
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Chen et al. (2026) conducted an observational in Atrial fibrillation and atrial flutter. Tobacco exposure vs. 1990 baseline was evaluated on Age-standardized mortality rate (ASMR) of AF/AFL attributable to tobacco (-19.11% change, 95% CI -29.39 to -7.3). Tobacco exposure accounted for 10,012 deaths and 396,210 DALYs from atrial fibrillation and flutter globally in 2021, with absolute deaths increasing by 109.9% since 1990 despite a 19.1% decline in age-standardized mortality.
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