# Global burden of tobacco-induced atrial fibrillation/flutter: Trends from 1990 to 2021 and projections to 2045 based on the Global Burden of Disease study

## TL;DR

This study shows that tobacco use causes a significant and growing global burden of atrial fibrillation/flutter, with rising cases and deaths despite declining rates in some regions.

## Contribution

The paper provides the first comprehensive global projection of tobacco-induced AF/AFL burden up to 2045 using the GBD study data.

## Key findings

- In 2021, tobacco-related AF/AFL caused over 10,000 deaths and 400,000 DALYs globally.
- High SDI regions saw the most improvement, while low SDI regions lagged in reducing tobacco-related AF/AFL burden.
- By 2045, deaths from tobacco-related AF/AFL are projected to reach 14,500 and 4,200 in men and women, respectively.

## Abstract

Tobacco use is a key modifiable risk factor for atrial fibrillation/flutter (AF/AFL). We assessed global, regional, and national burdens attributable to smoking from 1990 to 2021 and projected future trends.

Data on deaths and DALYs were extracted from the GBD 2021 study. Main statistical analyses included the calculation of ASMR and ASDR. Trends were quantified using the estimated annual percentage change (EAPC). An age-period-cohort (APC) model was employed to decompose the effects of age, period, and birth cohort. Furthermore, a Bayesian age-period-cohort (BAPC) model was utilized to project the disease burden through 2045.

In 2021, AF/AFL related to tobacco caused around 396000 cases, more than 10000 deaths, and 400000 disability-adjusted life years (DALYs). Compared with 1990, absolute cases and DALYs increased, while ASDR and ASR DALY declined (20%). High SDI regions improved most; low SDI regions lagged. Men and older adults bore disproportionate burdens. By 2045, deaths are projected to reach 14500 and 4200, respectively. Despite rising absolute DALYs, ASMR and ASDR are expected to decline in both sexes.

Although standardized rates declined, the absolute burden of tobacco-related AF/AFL continues to rise, highlighting the urgent need for stronger tobacco control and targeted interventions in vulnerable populations.