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. 2025 May 30:12:1540750.
doi: 10.3389/fcvm.2025.1540750. eCollection 2025.

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

Zhilin Wang #  1   2 , Zhenghua Shi #  1   2 , Jiayi Shen #  1   2 , Susu Zhang  1   2 , Yunteng Fang  1   2 , Wuming Hu  1   2 , Lingchun Lv  1   2
Affiliations

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

Zhilin Wang et al. Front Cardiovasc Med. .

Abstract

Background: 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.

Methods: 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.

Results: 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.

Conclusion: 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.

Keywords: age-period-cohort (APC) analysis; atrial fibrillation/atrial flutter (AF/AFL); disability-adjusted life years (DALYs); global burden of disease (GBD); inequality; joinpoint regression; prediction; socio-demography index (SDI).

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Aged-specific number and age-standardized prevalence and incidence rates of AF/AFL in China. (A) Aged-specific prevalence number. (B) Age-standardized prevalence rate. (C) Aged-specific incidence number. (D) Age-standardized incidence rate.
Figure 2
Figure 2
Aged-specific number and age-standardized mortality and DALYs rates of AF/AFL in China. (A) Aged-specific mortality number. (B) Age-standardized mortality rate. (C) Aged-specific DALYs number. (D) Age-standardized DALYs rate.
Figure 3
Figure 3
Global trends in the all-age cases and age-standardized prevalence and incidence rates of AF/AFL by sex from 1990 to 2021. (A) Prevalence number and rate. (B) Incidence number and rate. (C) Mortality number and rate. (D) DALYs number and rate.
Figure 4
Figure 4
Trends of China in the all-age cases and age-standardized prevalence and incidence rates of AF/AFL by sex from 1990 to 2021. (A) Prevalence number and rate. (B) Incidence number and rate. (C) Mortality number and rate. (D) DALYs number and rate.
Figure 5
Figure 5
Joinpoint regression analysis of the sex-specific age-standardized incidence rate for AF/AFL worldwide from 1990 to 2021. (A) Age-standardized incidence rate for both. (B) Age-standardized incidence rate for males. (C) Age-standardized incidence rate for females.
Figure 6
Figure 6
Joinpoint regression analysis of the sex-specific age-standardized incidence rate for AF/AFL in China from 1990 to 2021. (A) Age-standardized incidence rate for both. (B) Age-standardized incidence rate for males. (C) Age-standardized incidence rate for females.
Figure 7
Figure 7
Joinpoint regression analysis of the sex-specific age-standardized mortality rate for AF/AFL worldwide from 1990 to 2021. (A) Age-standardized mortality rate for both. (B) Age-standardized mortality rate for males in worldwide. (C) Age-standardized mortality rate for females in worldwide.
Figure 8
Figure 8
Joinpoint regression analysis of the sex-specific age-standardized mortality rate for AF/AFL in China 1990 to 2021. (A) Age-standardized mortality rate for both. (B) Age-standardized mortality rate for males. (C) Age-standardized mortality rate for females.
Figure 9
Figure 9
Incidence and mortality rates of AF/AFL in China. (A) The age-specific incidence rates of AF/AFL according to time periods; each line connects the age-specific mortality for a 5-year period. (B) The age-specific incidence rates of AF/AFL according to birth cohorts; each line connects the age-specific mortality for a 5-year cohort. (C) The period-specific incidence rates of AF/AFL according to age groups; each line connects the birth cohort-specific mortality for a 5-year age group. (D) The birth cohort-specific incidence rates of AF/AFL according to age groups; each line connects the birth cohort-specific mortality for a 5-year age group. (E) The age-specific mortality rates of AF/AFL according to time periods; each line connects the age-specific mortality for a 5-year period. (F) The age-specific mortality rates of AF/AFL according to birth cohorts; each line connects the age-specific mortality for a 5-year cohort. (G) The period-specific mortality rates of AF/AFL according to age groups; each line connects the birth cohort-specific mortality for a 5-year age group. (H) The birth cohort-specific mortality rates of AF/AFL according to age groups; each line connects the birth cohort-specific mortality for a 5-year age group.
Figure 10
Figure 10
Changes in AF/AFL incidence (A) and mortality (B) according to population growth, aging, and epidemiological change from 1990 to 2021 at the China level and by gender. The black dot represents the overall value of change contributed by all 3 components.
Figure 11
Figure 11
Health inequality regression curves (A) and concentration (B) for the DALYs of AF/AFL from 1990 to 2021 across the world.
Figure 12
Figure 12
Trends of age-standardized incidence rate (ASIR) from 2021 to 2036 in females (A) and males (B) predicted by Bayesian age-period-cohort (BAPC) models.
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