Zhang Chuanmeng, Zhang Xiaohong, Zhou Ruifang, Ji Kun, Ding Xiangwei, Chu Ming, Wang Fan
Department of Epidemiology, School of Public Health, Harbin Medical University, Harbin, China.
Clinical Research Center, Taizhou School of Clinical Medicine, The Affiliated Taizhou People's Hospital of Nanjing Medical University, Nanjing Medical University, Taizhou, 225300, China.
BMC Public Health. 2025 Jun 3;25(1):2064. doi: 10.1186/s12889-025-23322-x.
BACKGROUND: Atrial fibrillation/flutter (AF/AFL) is the most common clinically significant arrhythmias in older adults, with an increased burden of disease due to the aging of Chinese population. Identifying and predicting secular trends in the incidence and mortality of AF/AFL in Chinese residents is crucial to facilitate optimal healthcare planning and improve the management of AF/AFL. METHODS: The incidence and death data of AF/AFL in China from 1992 to 2021 were sourced from the Global Burden of Disease Study 2021 database. The time trends of AF/AFL from 1992 to 2021 was analyzed using the joinpoint regression model. Additionally, the age-period-cohort model was used to estimate the age, period, and cohort effects on disease burden of AF/AFL and the Bayesian age-period-cohort (BAPC) approach was employed to forecast future trends in the next 25 years. RESULTS: For 1992-2021, the age-standardized incidence rate of AF/AFL in China increased annually by 0.46% (95% CI: 0.39-0.52) in males, whiles the change in females was not statistically different. In addition, the incidence rate of AF/AFL in both females and males showed an increasing trend in all age groups under 65 years old, and a decreasing trend in the older groups. The age-standardized mortality rate of AF/AFL in China decreased annually by 1.00 (0.76-1.24) in females, while there is no statistically significant difference in males. The age-period-cohort fitting results showed that older age, present period and past cohort were risk factors for the incidence and mortality rate of AF/AFL. The BAPC predicts that, the incidence and mortality of AF/AFL are expected to rise rapidly among both males and females due to population aging, potentially reaching several times the figures recorded in 2021, particularly among females, owing to their longer life expectancy compared to males. CONCLUSION: Given China's large population and rapid aging, AF/AFL poses a significant public health challenge, particularly in the future. Targeted efforts to reduce the prevalence of risk factors, increase screening coverage rates and strengthen the management of AF/AFL are necessary to deal with the situation.
背景：心房颤动/心房扑动（AF/AFL）是老年人中最常见的具有临床意义的心律失常，由于中国人口老龄化，疾病负担不断增加。识别和预测中国居民AF/AFL发病率和死亡率的长期趋势对于促进最佳医疗规划和改善AF/AFL的管理至关重要。 方法：1992年至2021年中国AF/AFL的发病率和死亡数据来自《2021年全球疾病负担研究》数据库。使用Joinpoint回归模型分析1992年至2021年AF/AFL的时间趋势。此外，采用年龄-时期-队列模型估计年龄、时期和队列对AF/AFL疾病负担的影响，并采用贝叶斯年龄-时期-队列（BAPC）方法预测未来25年的趋势。 结果：1992年至2021年，中国男性AF/AFL的年龄标准化发病率每年增长0.46%（95%CI：0.39-0.52），而女性的变化无统计学差异。此外，65岁以下各年龄组的男性和女性AF/AFL发病率均呈上升趋势，而老年组呈下降趋势。中国女性AF/AFL的年龄标准化死亡率每年下降1.00（0.76-1.24），而男性无统计学差异。年龄-时期-队列拟合结果表明，年龄较大、当前时期和过去队列是AF/AFL发病率和死亡率的危险因素。BAPC预测，由于人口老龄化，男性和女性的AF/AFL发病率和死亡率预计将迅速上升，可能达到2021年记录数字的几倍，尤其是女性，因为与男性相比，她们的预期寿命更长。 结论：鉴于中国人口众多且老龄化迅速，AF/AFL构成了重大的公共卫生挑战，尤其是在未来。有针对性地努力降低危险因素的流行率、提高筛查覆盖率并加强AF/AFL的管理对于应对这种情况是必要的。
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