Contribution of alcohol use and smoking to the global burden of atrial fibrillation from 1990 to 2019 and projections to 2044

Abstract Background The prevalence of atrial fibrillation has quadrupled in the last few decades. With socio-demographic issues such as ageing becoming more prominent, the soaring healthcare costs associated with AF treatment suggests that we are facing a major public health issue. In 2019, with 4.7 million cases of AF/heart failure and more than 300,000 related deaths, China led the world in the number of incident cases, cases of DALYs, and deaths are the highest in the world.Methods Based on the Socio-Demographic Index (SDI), 204 countries and territories can be categorised into five regions, including low, medium, intermediate, high and high. Considering geological consistency, these countries and areas can be divided into 21 regions.Result In 2019, there were more than 20,000 (95% IU, 0.17–0.29) AF deaths due to alcohol consumption, accounting for 30% of all AF deaths. The corresponding age-standardised death rate (ASDR) declined by 0.126% per year(95% UI, -0.193 to -0.059) from 1990 to 2019 (Table 1). In the same year, there were 730,000 (95% UI, 5.1 to 10.1) DALYs for AF due to alcohol consumption globally.Conclusions It is fortunate that there is no clear exponential rise in AF resulting from global alcohol and tobacco use, and the primary burden is found in countries with medium to high socio-demographic indices. While there is a gradual increase in deaths and DALYs caused by alcohol and tobacco use worldwide, ASDR and age-standardised DALY rates are marginally decreasing.