# Global burden of atrial fibrillation/flutter attributable to a high body mass index (HBMI) from 1990–2021

## TL;DR

This study shows how obesity has increased heart rhythm disorders globally, especially affecting older women and men in wealthy regions.

## Contribution

The study provides new insights into how obesity-related atrial fibrillation/flutter burden has evolved by gender and region over three decades.

## Key findings

- HBMI-related AF/AFL caused 27,236 deaths and 724,573 DALYs in 2021, with significant increases since 1990.
- Men showed faster growth in mortality and disability rates compared to women, especially in high-SDI regions.
- Health inequalities in AF/AFL burden have decreased over time, but future trends suggest a shift in disease burden toward men.

## Abstract

This study leveraged the Global Burden of Disease (GBD) database to assess sex- and region-specific trends in obesity-attributable atrial fibrillation and atrial flutter (AF/AFL) over the past three decades. We aimed to unravel temporal dynamics to inform evidence-based prevention and clinical management strategies.

Using 2021 GBD data, we evaluated the AF/AFL burden attributable to high body mass index (HBMI). Our analysis included deaths, age-standardized rates (ASR), disability-adjusted life years (DALYs), and estimated annual percentage changes (EAPC), stratified by age group, gender, Sociodemographic Index (SDI), and region. We also assessed health inequalities using the Gini coefficient and conducted hypothesis testing to examine relationships between mortality, disability rates, and gender from 1990 to 2021.

In 2021, HBMI-related AF/AFL caused 27,236 deaths and 724,573 DALYs globally. These figures represent increases of 66.7% and 272.5%, respectively, compared to 1990. The age-standardized mortality rate (ASMR) and DALY rate rose by 66.7% and 67.8%. Nearly half of the disease burden occurred in high and upper-middle SDI regions; however, other SDI regions are experiencing a rapid increase in burden. Notably, elderly women aged 65 + bore the highest disease burden. The Gini index for DALY rates declined from 0.45 in 1990 to 0.35 in 2020, indicating reduced health inequality. While women had a higher overall burden, men exhibited faster growth in mortality and disability rates. Over the past 30 years, the EAPC for DALYs and mortality in men was 1.76 and 1.85 times higher, respectively, than in women. Critically, in high-SDI regions, men’s absolute disability burden and rates have surpassed women’s across all age groups.

Disparities in the HBMI-attributable AF/AFL burden (HAB) across sociodemographic strata have narrowed significantly over the past three decades, reflecting progressive mitigation of structural health inequities. Economic advancement propagates the HAB across the development spectrum, and temporal analysis confirms this trajectory. The current burden profile observed in high-SDI regions suggests the future epidemiological path for lower-SDI settings. GBD projections indicate an impending reversal of the AF/AFL burden sex differential. Accelerating male-predominant obesity trends are poised to drive disproportionate burden escalation in coming decades. Targeted screening and early therapeutic intervention in young obese cohorts may mitigate future burden escalation among aging populations.

The online version contains supplementary material available at 10.1186/s12872-025-05125-5.