Background: Atrial Fibrillation (AF) associated with Chronic Kidney Disease (CKD) is a prevalent condition in the United States, significantly impacting global morbidity and mortality. Understanding temporal patterns in AF-related mortality among CKD patients is crucial for effective clinical and public health strategies. This study aimed to evaluate trends and regional disparities in AF-associated CKD mortality among U.S. adults
Methods: Death certificates from the CDC WONDER database spanning 2011-2020 were analyzed to investigate AF-related CKD mortality in adults aged 35 to 85+. Age-adjusted mortality rates (AAMRs) per 100,000 persons and annual percent change (APC) were calculated, stratified by year, sex, race/ethnicity, and geographic region
Results: A total of 110,733 deaths occurred among adults (aged 35-85 + years) between 2011 and 2020 related to AF associated with CKD in the U.S. Overall AAMR declined from 8.1 in 2011 to 5.5 in 2014 (APC: -14.89; 95% CI: -30.44 to -4.06), followed by an increase to 10.3 in 2020 (APC: 9.91; 95% CI: 6.119.62). Men consistently had higher AAMRs than women (men: 7.6, 95% CI: 7.6-7.7; women: 4.5, 95% CI: 4.4-4.5), with respective AAMRs of 10.3 and 5.9 at the study’s end. Non-Hispanic White adults had the highest AAMR (7.8), followed by NH Black or African American (5), NH American Indian or Alaska Native (3.8), NH Asian or Pacific Islander (2.6), and Hispanic or Latino (2.2) adults. States in the top 90th percentile (Minnesota, Washington, Oregon, Wisconsin, Nebraska, North Dakota and Indiana) had approximately four times higher AAMRs than those in the lower 10th percentile (Nevada, Florida, Alabama, Georgia, Louisiana, New Mexico, and New York.). AAMR also varied by region (Midwest: 7.6, West: 6.7, Northeast: 6.3, South: 5.6), with nonmetropolitan areas exhibiting higher AF-associated CKD mortality (AAMR: 8) compared to metropolitan areas (6.1).
Conclusions: In conclusion, our study underscores a notable increase in mortality linked to atrial fibrillation associated with chronic kidney disease among adults from 2011 to 2020. Particularly high mortality rates were observed among Non-Hispanic White populations, followed by Non-Hispanic Black or African American adults, males, residents in the Midwest U.S. regions, and those in non-metropolitan areas aged 35 years and older. Addressing mortality associated with atrial fibrillation and Chronic Kidney Disease complications demands enhanced preventive and management strategies, especially among older adults.
