Wei Zhen, Wang Qi, Jia Hong-Ling
School of Acupuncture and Tuina, Shandong University of Traditional Chinese Medicine, Jinan, China.
Department of Acupuncture, Second Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, China.
Front Nutr. 2025 May 15;12:1560334. doi: 10.3389/fnut.2025.1560334. eCollection 2025.
Atrial fibrillation/flutter (AF/AFL) remains a significant global public health issue, with its development influenced by metabolic, behavioral, and environmental risk factors However, comprehensive analyses of temporal and geographic variations in AF/AFL burden attributed to risk factors remain lacking.
This study reveals the geographic and temporal distribution of the burden of AF/AFL attributable to specific risk factors at global, regional, and national levels from 1990 to 2021, providing a scientific basis for developing targeted prevention and control policies.
We extracted data on AF/AFL risk-attributable deaths, disability-adjusted life years (DALYs), age-standardized mortality rates (ASMRs), and age-standardized DALY rates (ASDRs) from the Global Burden of Disease (GBD) database for the years 1990 to 2021. The burden of AF/AFL caused by metabolic, behavioral, and environmental risk factors stratified by age, sex, region, and country. Long-term trends in the AF/AFL burden associated with specific risk factors were assessed using the average annual percentage change (AAPC).
Over the past 32 years, high body mass index has been the primary contributor to the rising AF/AFL burden, with AAPCs of ASMR and ASDR at 1.66 (95% CI: 1.63-1.68) and 1.68 (95% CI: 1.67-1.70), respectively. The most significant increase occurred in males aged 30-34. The burden related to high sodium diets and lead exposure is also rising, particularly in females aged 65-69. Smoking showed the greatest decrease, with AAPCs of ASMR and ASDR at -0.66 (95% CI: -0.68 to -0.65) and -0.72 (95% CI: -0.72 to -0.71), most significantly in women aged 30-34. High systolic blood pressure decreased overall, but increased in individuals aged 34-49. East Asia saw the largest increase in burden from high body mass index, with AAPCs of ASMR at 8.28 (95% CI: 8.18-8.37) and ASDR at 8.22 (95% CI: 8.18-8.26). In 2021, China had the highest AF/AFL deaths and DALYs attributed to high systolic blood pressure, high sodium diets, smoking, and lead exposure.
From 1990 to 2021, high body mass index became the primary driver of the rising global AF/AFL burden, particularly affecting East Asia and young and middle-aged adults. In contrast, the burden associated with smoking showed the greatest decline. In 2021, China had the highest AF/AFL burden due to various risk factors. Given the regional variations and characteristics of high-risk populations, policymakers should develop targeted yet comprehensive prevention strategies. These measures should include promoting healthy dietary habits, strengthening global surveillance systems, and fostering data-sharing collaborations to mitigate this growing epidemic.
心房颤动/心房扑动（AF/AFL）仍然是一个重大的全球公共卫生问题，其发展受到代谢、行为和环境风险因素的影响。然而，对于归因于风险因素的AF/AFL负担的时间和地理变化的综合分析仍然缺乏。
本研究揭示了1990年至2021年全球、区域和国家层面归因于特定风险因素的AF/AFL负担的地理和时间分布，为制定有针对性的预防和控制政策提供科学依据。
我们从全球疾病负担（GBD）数据库中提取了1990年至2021年期间AF/AFL风险归因死亡、伤残调整生命年（DALYs）、年龄标准化死亡率（ASMRs）和年龄标准化DALY率（ASDRs）的数据。按年龄、性别、地区和国家对代谢、行为和环境风险因素导致的AF/AFL负担进行分层。使用平均年度百分比变化（AAPC）评估与特定风险因素相关的AF/AFL负担的长期趋势。
在过去32年中，高体重指数一直是AF/AFL负担上升的主要因素，ASMR和ASDR的AAPC分别为1.66（95%CI：1.63 - 1.68）和1.68（95%CI：1.67 - 1.70）。最显著的增加发生在30 - 34岁的男性中。与高钠饮食和铅暴露相关的负担也在上升，特别是在65 - 69岁的女性中。吸烟的下降最为显著，ASMR和ASDR的AAPC分别为 - 0.66（95%CI： - 0.68至 - 0.65）和 - 0.72（95%CI： - 0.72至 - 0.71），在30 - 34岁的女性中最为明显。高收缩压总体上有所下降，但在34 - 49岁的个体中有所增加。东亚地区高体重指数导致的负担增加幅度最大，ASMR的AAPC为8.28（95%CI：8.18 - 8.37），ASDR的AAPC为8.22（95%CI：8.18 - 8.26）。2021年，中国因高收缩压、高钠饮食、吸烟和铅暴露导致的AF/AFL死亡和DALYs最高。
从1990年到2021年，高体重指数成为全球AF/AFL负担上升的主要驱动因素，尤其影响东亚地区以及中青年人群。相比之下，与吸烟相关的负担下降最为显著。2021年，中国因各种风险因素导致的AF/AFL负担最高。鉴于地区差异和高危人群的特征，政策制定者应制定有针对性且全面的预防策略。这些措施应包括促进健康的饮食习惯、加强全球监测系统以及促进数据共享合作，以缓解这一日益增长的流行病。
