Cancer and atrial fibrillation mortality: worsening national trends over 25 years

Abstract Background Atrial fibrillation (AF) affects over 59 million people globally, with this number projected to rise to over 72 million by 2050. Globally, it is estimated that 1 in 6 people will be diagnosed with cancer in their lifetime. It has been shown that cancer can increase the risk of developing AF, with contributing factors including inflammation, metabolic changes and importantly, chemotherapeutic agents used to treat cancer. Current trends in mortality related to cancer and AF have not been investigated. Purpose To investigate trends in total mortality related to cancer and AF in the United States. Methods The Centers for Disease Control Wide Ranging Online Data for Epidemiological Research (CDC WONDER) Multiple Cause of Death database was queried from 2000 – 2024 for cancer and AF listed as underlying causes of death, using International Classification of Diseases-10 codes for Malignant Neoplasms (I48) and Atrial Fibrillation/Flutter (I48). Annual age-adjusted mortality rates per 100,000 population were obtained for overall total, sex, and region (as stratified by the U.S. census bureau). Confidence intervals were supplied directly by CDC WONDER. Results A total of 507,160 cancer and AF-related deaths occurred between 2000 and 2024. The overall age-adjusted cancer and AF-related mortality increased between 2000 to 2024, from 3.4 (95% CI: 3.3-3.5) to 8.6 (95% CI: 8.5-8.6) (Figure 1). The annual age-adjusted cancer and AF-related mortality was higher for men than for women for all years (Figure 1). Over the 25 year span for men, the age-adjusted cancer and AF-related mortality increased from 5 (95% CI: 4.8-5.) to 12.1 (95% CI: 11.9-12.2) and for women increased from 2.5 (95% CI: 2.4-2.6) to 6 (95% CI: 5.9-6.1). All regions had an increase in age-adjusted cancer and AF-related mortality. Rates were relatively stable between 2000- 2011. From 2012 - 2025 there was a more rapid rate of increase (Figure 2): the West North Central region had the highest change (8 points) from 5 (95% CI: 4.7-5.3) to 11.3 (95% CI: 10.9-11.7), the Mountain region had the second highest change (5.2 points) from 3.4 (95% CI: 3.2-3.7) to 8.6 (95% CI: 8.3-8.9) and the West South Central region had the 3rd highest change (4.7 points) from 5 (95% CI: 4.7-5.2) to 9.7 (95% CI: 9.4-10). Conclusions Over the past 25 years, mortality related to cancer and AF has increased over time for both men and women, with a higher age-adjusted mortality for men than women. Notably and concerningly, there appeared to be a more rapid rate of increase in cancer and AF-related mortality in the central regions of the U.S.. Factors contributing to these sex and regional differences need further investigation so that targeted interventions may help to change outcomes.Figure 1Figure 2