Abstract Body (Do not enter title and authors here): Abstract
Background: Atrial Fibrillation (AF) in patients with metabolic syndrome is a substantial health concern among older adults in the United States. This study investigated trends and disparities in AF mortality among older adults aged 65 and older with metabolic syndrome from 1999-2020.
Methods: We used the Centers for Disease Control database for mortality statistics with an underlying cause of death of AF in metabolic syndrome (ICD code I48 for AF and scattered codes indicating metabolic syndrome i.e. E10-14, E66, E78, E88, I10) between the years 1999 – 2020. Age-adjusted mortality rates (AAMR) were calculated per 100,000 deaths. The AAMR were assessed by demographic variables, including race, geographic density, sex, age, and US Census Region. Temporal trends were evaluated using Joinpoint regression software. Average annual percent change (AAPC) was considered statistically significant if p < 0.05.
Results: Between 1999 and 2020, AF in metabolic syndrome caused 944,960 deaths among U.S. adults aged 65+. Most deaths occurred in medical facilities (35.8%). The overall AAMR for AF in metabolic syndrome-related deaths rose from 36.6 in 1999 to 173.4 in 2020, with an AAPC of 6.48 (95% CI: 5.07 to 7.77, p < 0.000001). A significant increase was noted from 1999 to 2001 (APC: 26.58; 95% CI: 6.04 to 43.91, p < 0.000001), followed by a continued rise from 2001 to 2020 (APC: 4.56; 95% CI: 3.60 to 5.15, p = 0.012797). Older men had higher AAMRs than older women (116.0 vs 92.3). Among racial/ethnic groups, White population had the highest AAMRs (108.8) and AAPC (6.70; 95% CI: 5.23 to 7.95), followed by American Indians/Alaska Natives (81.7), Blacks (74.1), Hispanics (68.2), and Asians (61.6). AAMRs varied by state, from 61.1 in Nevada to 170.0 in Vermont. The Western region had the highest average AAMR (116.7). Nonmetropolitan areas had slightly higher AAMRs than metropolitan areas (113.0 vs. 99.9).
Conclusion: The analysis reveals a dramatic fourfold increase in AF-related mortality within metabolic syndrome among older U.S. adults over two decades. This substantial rise in mortality rates underscores the urgent need for targeted interventions and strategies to address these trends. By addressing structural barriers to quality healthcare and health disparities, we can effectively counter this concerning trend and achieve positive outcomes for this vulnerable group.