# A Retrospective Study on Temporal Trends in Mortality Related to Atrial Fibrillation and Chronic Obstructive Pulmonary Disease

## TL;DR

This study examines how deaths from atrial fibrillation and chronic obstructive pulmonary disease have changed over time in the U.S., finding rising trends until 2015 and ongoing disparities.

## Contribution

The study is the first to analyze mortality trends for atrial fibrillation with COPD as a contributing cause using U.S. national data from 1999 to 2020.

## Key findings

- Age-adjusted mortality rates for AF with COPD increased from 1999-2004 to 2004-2015, then plateaued after 2015.
- Higher mortality was observed in females, White patients, and those in metropolitan areas.
- Disparities in mortality were found by race, gender, and geographic location.

## Abstract

Introduction: Atrial fibrillation (AF) is a major cause of mortality, and its association with chronic obstructive pulmonary disease (COPD) remains unexplored. Individuals with these diseases have increased mortality and morbidity rates.

Aims: This study aimed to analyze mortality trends and demographic disparities in AF with COPD as a contributing cause using the CDC Wide-Ranging Online Data for Epidemiologic Research (CDC WONDER) Multiple Causes of Death (MCD) database from 1999 to 2020.

Methodology: A retrospective observational study was conducted using the CDC WONDER MCD database to assess mortality trends in individuals aged 25 years and older in the United States from 1999 to 2020. The study included deaths where AF (International Classification of Diseases, 10th Revision (ICD-10): I-48) was listed as the underlying cause and COPD (ICD-10: J40-J44) as a contributing cause. Data were analyzed by urbanization, gender, race, geographic region, and place of death. Age-adjusted mortality rates (AAMR) and annual percentage change (APC) were calculated using statistical analysis software JoinPoint, version 5.4.0, developed by the National Cancer Institute, Bethesda, MD.

Results: A total of 37,738 deaths were recorded. The AAMR for AF with COPD increased over time from 1999-2004 (APC: 6.82) to 2004-2015 (APC: 8.37), and then it plateaued from 2015 to 2022 (APC: -0.15). The highest mortality was observed in females, White patients, and metropolitan areas. Temporal trends showed that the mortality increased with time and became steady after 2015; there is a wide disparity in the mortality in races, and more in people living in metropolitan areas.

Conclusions: This study highlights significant mortality trends increasing in all AF with COPD, and from 2015, it is at a steady rate, with disparities by gender, race, and location. Findings underscore the need for targeted prevention strategies and improved healthcare access.