# Analysis and comparison of the trends in burden of atrial fibrillation/atrial flutter in China and worldwide from 1990 to 2021 and predictions to 2036 of China

## TL;DR

This study analyzes the growing global and Chinese burden of atrial fibrillation/flutter, predicts future trends, and highlights the need for targeted interventions.

## Contribution

The paper provides a detailed analysis of AF/AFL trends in China and globally, including future projections using Bayesian age-period-cohort modeling.

## Key findings

- The global and Chinese burden of AF/AFL has increased, with China reporting 10.78 million prevalent cases in 2021.
- Epidemiological shifts and aging populations drive rising incidence and mortality rates.
- The age-standardized incidence rate in China is projected to continue increasing over the next 15 years.

## Abstract

It is essential to analyze the burden, trends, and inequalities of atrial fibrillation/flutter (AF/AFL) in China and to predict future trends, with the aim of raising awareness about risk factors and exploring strategies to control the significant disease burden.

Data pertaining to AF/AFL were extracted from the comprehensive dataset of the Global Burden of Disease, Injuries, and Risk Factors Study 2021 (GBD 2021). Furthermore, we analyzed the epidemiological characteristics of AF/AFL and compared them to global prevalence trends, employing joinpoint regression, decomposition, age-period-cohort (apc), and cross-country inequality analysis methods. Concurrently, we utilized a Bayesian age-period-cohort (BAPC) analysis to forecast the age-standardized incidence rate (ASIR) of AF/AFL in China over the subsequent 15 years.

Globally, in 2021, there were 52.55 million [95% uncertainty interval (UI): 43.14 to 64.96] prevalent cases, 4.48 million (95% UI: 3.61 to 5.71) incident cases, 0.34 million (95% UI: 0.28 to 0.37) deaths, and 8.36 million (95% UI: 6.97 to 10.13) DALYs. In China, during the same year, there were 10.78 million (95% UI: 8.53 to 14.01) prevalent cases, 0.92 million (95% UI: 0.71 to 1.20) incident cases, 0.06 million (95% UI: 0.05 to 0.08) deaths, and 1.65 million (95% UI: 1.30 to 2.06) DALYs. The average annual percentage change (AAPC) in age-standardized incidence and mortality rates for AF/AFL were −0.02 (95% CI: −0.05, 0) and 0.11 (95% CI: 0.03, 0.18) globally, and 0.16 (95% CI: 0.05, 0.26) and −0.45 (95% CI: −0.78, −0.12) in China, respectively. Decomposition analysis revealed epidemiological shifts drive incidence rise, aging affects mortality. The Slope Index of Inequality (SII) 2021 was −35.04, and the Concentration Index (CI) was −0.09. The BAPC results indicated that the ASIR for males and females is expected to rise over the next 15 years.

The burden of AF/AFL continues to increase annually. Countries with medium to low Socio-Demographic Index (SDI) have a heavy disease burden. In recent years, the burden in Chinese females has begun to exceed that of males. Without effective measures, the ASIR of AF/AFL is projected to exhibit a continued upward trajectory.