Global burden of atrial fibrillation and atrial flutter due to high alcohol use from 1990 to 2021: estimates from the global burden of disease study 2021.

OBJECTIVE

This study comprehensively examines the global burden of atrial fibrillation and atrial flutter (AF/AFL) attributable to high alcohol use from 1990 to 2021, analyzing temporal trends, regional disparities, and sociodemographic determinants using data from the Global Burden of Disease Study 2021 (GBD 2021).

METHODS

We extracted GBD 2021 estimates on deaths, disability-adjusted life years (DALYs), and age-standardized rates (ASRs) for AF/AFL due to high alcohol use across 204 countries. Joinpoint analysis and age-period-cohort (APC) modeling were employed to assess temporal trends and disentangle age, period, and cohort effects.

RESULTS

In 2021, AF/AFL attributable to high alcohol use contributed to 11,908 deaths (95% UI: 8,860, 14,981) and 362,698 DALYs (95% UI: 263,321, 465,594) globally, marking increases of 176.4% and 132.9%, respectively, since 1990. While age-standardized death rates (ASDR) remained stable (0.2 per 100,000), males bore 2.3-fold higher mortality and 3.7-fold greater DALYs than females. Western Europe had the highest burden (4,589 deaths; 109,934 DALYs), while Oceania reported the lowest (2 deaths; 68 DALYs). High Socio-Demographic Index (SDI) regions exhibited the largest absolute burden, yet low-middle SDI regions experienced the steepest ASDR growth (estimated annual percentage change (EAPC) of ASDR is 2.01%). APC models revealed diverging sex-specific trends: male mortality marginally increased (net drift = 0.091%/year) versus significant female declines (-0.925%/year). The mortality rates are notably elevated in the age groups of 30-39 and those over 75 years, with the highest peak observed in individuals aged 95 and above.

CONCLUSION

AF/AFL attributable to high alcohol use remains a critical public health challenge, disproportionately affecting males, high-SDI regions, and aging populations. Targeted interventions addressing alcohol consumption patterns, gender-specific risk mitigation, and healthcare disparities are urgently needed to reduce the growing burden, particularly in regions with accelerating trends.