Long-Term Mortality Trends in Atrial Fibrillation and Renal Disease in the United States, 1999–2023: A Retrospective Analysis

Abstract

Background: The coexistence of atrial fibrillation (AF) and renal disease is a significant contributor to mortality and morbidity. However, comprehensive national mortality trends for AF among older adults with renal disease, including demographic and geographic variations, remain largely unexamined. Methods: We performed a retrospective analysis of U.S. adult deaths (≥65 years) from 1999 to 2023 using the CDC WONDER Multiple Cause of Death database. Deaths were included when atrial fibrillation and kidney disease appeared in any mention field of the death certificate, regardless of the underlying cause of death. We calculated crude and age-adjusted mortality rates (CMR, AAMR) per 100,000 population, and temporal trends were assessed using Joinpoint regression to estimate annual percent change (APC) and average annual percent change (AAPC). Results: A total of 372,652 deaths were attributed to both AF and renal disease in older adults. The national AAMR increased more than threefold, from 16.67 in 1999 to 54.45 per 100,000 in 2023 (AAPC: 5.10; p < 0.001). Men had higher absolute mortality, but women experienced a slightly steeper increase in AAMR. Non-Hispanic White individuals had the highest absolute mortality, while all racial/ethnic groups showed significant increases. The South reported the most deaths, the Northeast had the highest AAMR, and non-metropolitan areas consistently showed higher AAMR than metropolitan areas. Most deaths occurred in medical facilities (54.55%). Conclusions: Mortality from AF and renal disease has substantially risen over the past 25 years, with marked disparities by sex, race/ethnicity, geography, and urbanization.