# Burden of atrial fibrillation and atrial flutter attributable to smoking in the G20: Trends from 1990 to 2021 and predictions for 2022 to 2050: A secondary dataset analysis of the Global Burden of Disease (GBD) 2021

## TL;DR

This study analyzes how smoking contributes to heart rhythm disorders in G20 countries from 1990 to 2021 and predicts future trends up to 2050.

## Contribution

The study provides the first comprehensive assessment of smoking-attributable AF/AFL burden trends and future projections in G20 countries.

## Key findings

- Smoking-attributable AF/AFL caused over 321,000 DALYs in G20 countries in 2021.
- Males and older adults (65–89 years) experienced the highest AF/AFL burdens.
- Projections show rising AF/AFL burdens despite stable age-standardized rates.

## Abstract

Atrial fibrillation and atrial flutter (AF/AFL) are major contributors to the cardiovascular disease burden in G20 countries. However, comprehensive assessments of smoking-attributable AF/AFL burden across the G20 remain limited. The objective of this study was to evaluate temporal trends in the AF/AFL burden attributable to smoking in G20 countries from 1990 to 2021 and to project future trends through 2050.

This secondary analysis used data from the Global Burden of Disease (GBD) 2021 study. Smoking-attributable disability-adjusted life years (DALYs), deaths, years lived with disability (YLDs), and years of life lost (YLLs) for AF/AFL were extracted for G20 countries between 1990 and 2021. Trends were analyzed by age, sex, and country, and estimated annual percentage changes (EAPCs) were calculated. Autoregressive integrated moving average (ARIMA) and exponential smoothing (ES) models were applied to project the disease burden from 2022 to 2050.

In 2021, smoking-attributable AF/AFL accounted for 321761.89 DALYs (95% UI: 187788.89–476327.05) in the G20. Overall age-standardized rates remained relatively stable from 1990 to 2021. Japan showed a declining trend, whereas Saudi Arabia and Indonesia exhibited increasing burdens. Males consistently experienced higher burdens than females, and the highest absolute burden occurred in individuals aged 65–89 years. Projections indicate that from 2022 to 2050, absolute numbers of deaths, YLDs, YLLs, and DALYs attributable to smoking-related AF/AFL will continue to rise, particularly among males, despite stable or slightly declining age-standardized rates.

Although age-standardized smoking-attributable AF/AFL rates in G20 countries have remained largely stable, absolute burdens are expected to increase substantially due to population growth and ageing. Pronounced sex- and country-level heterogeneity highlights the need for sustained and targeted tobacco control and cardiovascular prevention strategies.