Secular trend in disease burden of atrial fibrillation/flutter in China from 1992 to 2021 and its projection in 25 years

Atrial fibrillation/flutter (AF/AFL) is the most common clinically significant arrhythmias in older adults, with an increased burden of disease due to the aging of Chinese population. Identifying and predicting secular trends in the incidence and mortality of AF/AFL in Chinese residents is crucial to facilitate optimal healthcare planning and improve the management of AF/AFL. The incidence and death data of AF/AFL in China from 1992 to 2021 were sourced from the Global Burden of Disease Study 2021 database. The time trends of AF/AFL from 1992 to 2021 was analyzed using the joinpoint regression model. Additionally, the age-period-cohort model was used to estimate the age, period, and cohort effects on disease burden of AF/AFL and the Bayesian age-period-cohort (BAPC) approach was employed to forecast future trends in the next 25 years. For 1992-2021, the age-standardized incidence rate of AF/AFL in China increased annually by 0.46% (95% CI: 0.39-0.52) in males, whiles the change in females was not statistically different. In addition, the incidence rate of AF/AFL in both females and males showed an increasing trend in all age groups under 65 years old, and a decreasing trend in the older groups. The age-standardized mortality rate of AF/AFL in China decreased annually by 1.00 (0.76-1.24) in females, while there is no statistically significant difference in males. The age-period-cohort fitting results showed that older age, present period and past cohort were risk factors for the incidence and mortality rate of AF/AFL. The BAPC predicts that, the incidence and mortality of AF/AFL are expected to rise rapidly among both males and females due to population aging, potentially reaching several times the figures recorded in 2021, particularly among females, owing to their longer life expectancy compared to males. Given China's large population and rapid aging, AF/AFL poses a significant public health challenge, particularly in the future. Targeted efforts to reduce the prevalence of risk factors, increase screening coverage rates and strengthen the management of AF/AFL are necessary to deal with the situation.