Changing patterns of the burden for atrial fibrillation /atrial flutter attributable to high systolic blood pressure in China From 1990 to 2021

Changing patterns of the burden for atrial fibrillation /atrial flutter attributable to high systolic blood pressure in China From 1990 to 2021 | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Article Changing patterns of the burden for atrial fibrillation /atrial flutter attributable to high systolic blood pressure in China From 1990 to 2021 Bin Liu, Xiying Huang, Ziyong Hao, Jian Wang, Yiting Fan, Qin Shao, and 3 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-5946566/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract This study aims to investigate the changing patterns of the burden for atrial fibrillation (AF) /atrial flutter (AFL) attributed to high systolic blood pressure (SBP) in China. Data were sourced from the Global Burden of Disease (GBD) 2021 project. The disease burden of AF /AFL attributed to high SBP in China from 1990 to 2021 was analyzed stratified by sex and age, along with the trend prediction from 2022 to 2050. In China, between 1990 and 2021, the age-standardized mortality rate (ASMR) and the age-standardized disability-adjusted life years (DALYs) rate (ASDR) of AF/AFL attributable to high SBP in male have been increasing, and the trend will continue till 2050, whereas in female, the trend is slightly downward. Globally, however, the disease burden according to the estimated annual percentage changes (EAPC) of ASMR and ASDR presents a deducing trend in both genders between 1990 and 2021. The main driver of the increased DALY burden for AF /AFL attributed to high SBP is population aging. In China, the disease burden of AF/AFL attributable to high SBP in male has been increasing between 1990 and 2021 and keeps an upward trend till 2050, whereas in female, the trend is slightly downward. Our research implies that the public health decision-making needs to give sufficient attention to alleviate the burden of AF /AFL attributable to high SBP in China by promoting awareness, treatment, and controlling rates of hypertension, especially in male. Systolic blood pressure Global burden of disease Atrial fibrillation Disability-adjusted life years Epidemiology Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Figure 6 Introduction Atrial fibrillation (AF) /atrial flutter (AFL) is the most prevalent form of cardiac arrhythmia, often leading to a series of complications, including stroke, thromboembolism, heart failure, and reducing patients' quality of life. 1 Data from the Global Burden of Disease (GBD) Study indicate that the disability-adjusted life years (DALYs) due to AF in the Chinese population have been on an upward trend annually, excluding the effect of age composition. 2 With the acceleration of China's aging population, it is anticipated that the disease burden of AF /AFL will further increase. A national survey conducted in 2021 reported that the prevalence of AF /AFL among Chinese adults is 1.6%. 3 As a result, AF /AFL remains a significant public health concern in China. Hypertension is a known risk factor for AF /AFL, with a 19% increase in the risk of AF /AFL for every 10 mmHg increase in systolic blood pressure(SBP). 4 Hypertension is not only the primary correlate of the cardiovascular disease burden in China but also the most significant modifiable factor. 5 , 6 Data from the Chinese National Stroke Screening and Prevention Project (CNSSPP) between 2014 and 2015 show that 26.6% of the risk of AF occurrence is attributed to hypertension. 7 To date, there are no studies to explore the changes in mortality and DALY rates due to AF /AFL related to high SBP in China. Therefore, it is imperative to assess the trend of the disease burden of AF /AFL attributable to high SBP in China. In this study, we utilized the age-standardized mortality rates (ASMR) and the age-standardized DALY rates (ASDR) from the Global Burden of Disease 2021 (GBD 2021) to explore the changing patterns of the disease burden of AF /AFL attributable to high SBP in China from 1990 to 2021 and the trend prediction in the next 30 years. Furthermore, we employed the age-period-cohort (APC) model to analyze the potential impacts of age, sexes, period, and cohort on the ASDR of AF /AFL. Methods The GBD 2021 report utilizes the most recent epidemiological data and refined standardization methodologies to conduct a comprehensive assessment of the global burden of 371 diseases, injuries, and 88 risk factors across 204 countries and territories, stratified by age and sex. 8 , 9 In this study, the numbers of deaths and DALYs for AF /AFL and their corresponding age-standardized rates (ASR), with their 95% uncertainty interval (UI), are derived from the GBD 2021 data. In the GBD 2021 data, codes from the International Classification of Diseases (ICD-10) ranging from I48 to I48.9, as well as ICD-9 code 427.3, were used to identify AF/AFL. And, high SBP was defined as SBP above 110 to 115 mmHg. 9 Ethical approval and consent to participate The study was conducted in accordance with the Declaration of Helsinki (as revised in 2013). The study utilized the publicly available and free data, no patients were involved in the settings of research question or outcome measures, nor were they involved in the design or implementation of the study, so the agreement of the medical ethics committee board was not necessary. Statistical analysis Descriptive analysis Based on the latest -released GBD 2021 estimates, a comprehensive assessment was conducted to quantify the burden of AF /AFL attributable to high SBP, encompassing its mortality and DALYs rate at the global and Chinese levels. Furthermore, the study explored demographic factors affecting the burden of AF /AFL, by analyzing the disease's impact across various age groups and different genders. The ASMR and the ASDR for AF /AFL among males and females from 1990 to 2021 were visually represented in China and globally, with rates expressed per 100,000 population. Furthermore, the number of deaths and DALYs for AF /AFL and their corresponding ASRs for both genders were compared at the global and Chinese levels. Trend analysis To assess the trend changes in the ASR and all age-specific rates over a defined period, this study calculated the estimated annual percentage changes (EAPC). A linear model was established by fitting a regression line to the natural logarithm of the ASR, expressed as y = α + βx, where y represents the natural logarithm of the ASR, and x represents the calendar year. The EAPC is determined using the formula EAPC = 100% × (exp(β) − 1). This model also allows for the 95% Confidence Interval (CI) computation. 10 If both the estimated EAPC and the lower bound of its 95% CI are positive, it suggests an increasing trend in the ASR. On the other hand, if both the estimated EAPC and the upper bound of its 95% CI are negative, it indicates a declining trend in the ASR. If there is an overlap in the 95% CI, the ASR is considered stable. Decomposition analysis This study employs the decomposition method invented by Das Gupta to quantify the specific impacts of age structure, population growth, and epidemiological changes on the burden of AF /AFL attributable to high SBP. 11 , 12 APC model The study conducted an age-period-cohort analysis to assess the individual influences of age, period, and cohort factors on DALYs rate of AF /AFL attributable to high SBP. This analysis dissected the three distinct trends and yielded more precise estimation outcomes. 13 The age effect indicates the physiological and societal aspects of the aging process. The period effect signifies the temporal shifts in DALYs of AF/AFL due to high SBP in all age groups. The cohort effect refers to changes from diverse risk factors and environmental influences experienced by a specific group of individuals (cohorts) over time. 14 In current research, we concentrated on estimating the net drift, the local drift, the longitudinal age curve, and the period and cohort rate ratios (RRs). Net drift signifies the aggregate logarithmic trend across different periods and birth cohorts, reflecting the general annual percentage alteration in the anticipated ASR as time progresses. Local drift is the average annual percentage change (AAPC) for each age group after accounting for period and birth cohort effects. The longitudinal age curve is the age-specific longitudinal rates adjusted for cohort and period effects. Lastly, the period (cohort) RRs represent the relative risk of a period (or cohort) compared to a reference period (or cohort), adjusted for age and non-linear cohort (or period) effects. 15 In conducting the age-period-cohort analysis, the study organized the data on the number of DALYs and population into sequential 5-year spans ranging from 1990 to 2021, and into consecutive 5-year age brackets starting from 30–34 up to 95+. Given the challenge of dividing the data from 1990 and 1991 into full 5-year segments, a decision was made to omit these two years from the analysis. Because the DALY cases in those aged < 30 years were rare in the GBD 2021 database, they were excluded from this study. Autoregressive integrated moving average model The Autoregressive Integrated Moving Average (ARIMA) model is a widely used statistical method for prediction of time series data in epidemiology. 16 In this study, we employed the R programming language to construct an ARIMA model, to forecast the burden of AF /AFL attributable to high SBP in China from 2022 to 2050. Results ASMR and ASDR trends on AF /AFL attributable to high SBP in China and globally Table 1 and Table 2 show the number of deaths and DALYs along with their corresponding ASRs in China and globally from 1990 to 2021, as well as the EAPC over the same period. Globally, the ASMR and ASDR for AF /AFL attributable to high SBP have shown a significant downward trend. Figure 1 depicts the trends in ASRs and the number of deaths and DALYs for AF /AFL attributable to high SBP in China and globally from 1990 to 2021. The global ASMR for AF /AFL attributable to high SBP decreases from 1.4 per 100,000 in 1990 to 1.3 per 100,000 in 2021, with an EAPC of -0.11 (95% CI, -0.15 to -0.07), and the ASDR decreases from 31.8 to 30.5, with an EAPC of -0.2 (95% CI, -0.23 to -0.17). In contrast, China's ASMR and ASDR for AF /AFL attributable to high SBP, although slightly lower than the global average, display different trends. Exactly, the ASMR is relatively stable, holding at about 1.3 per 100,000 population, with an EAPC of -0.17 (95% CI, -0.35 to 0.02), whereas the ASDR increases from 23.7 to 26.7 per 100,000 population, with an EAPC of 0.34 (95% CI, 0.22 to 0.46) (Table 1 and Table 2 ). Table 1 The disease burden of the mortality for atrial fibrillation /atrial flutter attributable to high systolic blood pressure in China and the Global in 1990 and 2021. Location Sex 1990 2021 Percentage changes of ASR from 1990 to 2021 1990–2021 EAPC (95% CI) No (95% UI) ASR per 100,000 (95% UI) No (95% UI) ASR per 100,000 (95% UI) China Male 1277 (412,2269) 0.8 (0.3,1.5) 6466 (2085,11190) 1.1 (0.4,1.9) 30.2 (-15,125.3) 0.96 (0.77,1.15) Female 3034 (1067,5605) 1.5 (0.5,2.9) 13121 (4460,23344) 1.4 (0.5,2.5) -7.5 (-41.8,50.2) -0.46 (-0.66, -0.27) Both 4311 (1499,7497) 1.3 (0.4,2.4) 19587 (6868,32943) 1.3 (0.5,2.2) -0.8 (-31.9,47.2) -0.17 (-0.35,0.02) Global Male 13155 (4707,21344) 1.3 (0.5,2.1) 39391 (14422,64872) 1.3 (0.5,2.1) 0.3 (-9.8,12.7) 0.01 (-0.02,0.04) Female 23699 (9086,37551) 1.4 (0.5,2.2) 64032 (22374,106403) 1.3 (0.5,2.2) -3.5 (-14.6,8.2) -0.17 (-0.22, -0.12) Both 36854 (13821,58446) 1.4 (0.5,2.2) 103423 (36820,170727) 1.3 (0.5,2.2) -2.3 (-11.4,6.6) -0.11 (-0.15, -0.07) ASR, age-standardized rate for mortality; 95% UI, 95% uncertainty interval; 95% CI, 95% confidence interval; EAPC, estimated annual percentage change. Table 2 The disease burden of the DALY for atrial fibrillation /atrial flutter attributable to high systolic blood pressure in China and the Global in 1990 and 2021. Location Sex 1990 2021 Percentage changes of ASR from 1990 to 2021 1990–2021 EAPC (95% CI) No (95% UI) ASR per 100,000 (95% UI) No (95% UI) ASR per 100,000 (95% UI) China Male 51682 (16659,94267) 19.4 (6.2,34.8) 219765 (70786,385231) 26 (8.4,44.7) 33.9 (0.6,90.3) 1.13 (1,1.26) Female 72639 (24440,129401) 25.5 (8.7,45.6) 273828 (88986,478055) 26.5 (8.8,46.6) 4.1 (-25.9,49.3) -0.04 (-0.17,0.09) Both 124321 (41104,218221) 23.7 (7.9,41.7) 493593 (166429,854027) 26.7 (9.1,46.3) 12.7 (-12.8,49.6) 0.34 (0.22,0.46) Global Male 474123 (158341,789987) 33.5 (11.2,55.3) 1175342 (392021,1988353) 32.6 (10.8,55.1) -2.6 (-9.3,5.2) -0.09 (-0.1, -0.08) Female 575205 (203721,929976) 30.1 (10.7,48.7) 1339240 (448977,2216431) 28.5 (9.6,47.2) -5.2 (-12.9,3.1) -0.29 (-0.34, -0.25) Both 1049327 (362165,1717378) 31.8 (11,51.7) 2514582 (849855,4226734) 30.5 (10.3,51.4) -3.9 (-10.2,2.2) -0.2 (-0.23, -0.17) ASR, age-standardized rate for DALY; DALY, disability-adjusted life year; 95% UI, 95% uncertainty interval; 95% CI, 95% confidence interval; EAPC, estimated annual percentage change. In terms of gender differences, from 1990 to 2021, the EAPC values for ASMR and ASDR in female are both under zero, which are lower than those in male both in China and globally, indicating a declining trend in female in the disease burden of AF/AFL attributable to high SBP. However, in China, the EAPC values for ASMR and ASDR in male are both over zero, reflecting an ascending trend since 1990 (See Table 1 , Table 2 , Fig. 1 , and Fig. 2 ). As described in Fig. 1 , between 1990 and 2021, the number of deaths and DALYs and their corresponding ASRs in female caused by AF /AFL attributable to high SBP has been significantly higher than in male in China and globally. It is worth noting that before 2013, the ASDR in Chinese female was significantly higher than in male, but it presents a downward trend and maintains a similar level to that in male since 2013. Net drift and local drift in different age groups In this study, the local and net drifts on DALYs were calculated and analyzed using the APC model, and the results are presented in Fig. 3 A and the Supplementary Table S1 . The colored horizontal dashed lines in the figure represent the net drift for each group, while the solid lines depict the local drift. The net drift for ASDR is > 0 in all groups, suggesting that their ASDR has an upward trend after adjusting for the period and cohort from 1992 to 2021. The local drift curve in male exhibits a U-shape and intersects with the net drift curve at two points, implying the proportion in male in the age groups before 65 to 70 years and those above 95 years is on an upward. The local drift curve in female descends with age and intersects with the net drift curve near 65 to 70 years, reflecting the disease burden of AF/AFL in female tends to decrease in the elderly population. The EAPC in DALYs for various age groups in China from 1992 to 2021 was presented in Supplementary Table S2, with results similar to those observed in the local drift analysis. APC effects on AF /AFL The longitudinal age curves of the AF /AFL attributable to high SBP in China is illustrated in Fig. 3 B. The results found that the DALYs rate for AF /AFL increases significantly with age in both genders. The DALYs rate per 100,000 people increases from 0.07 in the 30 to 35-year-old age group to 2280.1 in the 95 + years old age group. Figures 3 C and Figs. 3 D present the period rate ratio (PRR) and cohort rate ratio (CRR) of DALY for AF /AFL attributable to high SBP in China, respectively. Before 2002 to 2007, the risk in female was always higher than that in male, but after 2002 to 2007, the risk in male has been significantly higher than in female. It is noteworthy that the increasing trends of period effects in male are more pronounced than in female. The CRR for AF /AFL has increased in both genders, indicating a general rise in relative risk for both sexes. In patients born before 1942, the relative risk in female is generally higher than in male, however, born after 1942, there is a significant rise in the relative risk in male, which exceeded that in female. Age and sex patterns The DALYs for various age groups in China from 1990 to 2021, along with the corresponding rates, were displayed in Supplementary Table S3, Table S4, and Table S5. As described in Fig. 4 , from 1990 to 2021, the DALYs rate has exhibited a continuous upward trend with age, and the elderly are the main contributors to the increased number of DALYs. For male, the DALYs rate over 90 shows a significant upward trend starting from 2002, while for female, the trend is slightly downward since 2003. In contrast, the DALYs rate is relatively stable in other age groups among both genders. Decomposition analysis Decomposition analysis indicates that from 1990 to 2021, the burden of AF /AFL attributable to high SBP in China, as measured by DALYs, has significantly increased. In the past 32 years, the number of DALYs in China has increased by 1756812.54 (a 1413.13% increase than in 1990), with 1077162.56 in male (a 2084.20% increase), and 836634.87 in female (a 1151.78% increase). The increase in the burden of AF /AFL attributable to high SBP in China, is primarily driven by aging. Over the past 32 years, the aging factor has led to a 71.95% increase in DALYs, with an 81.82% increase in female and a 43.34% increase in male driven by aging, respectively (Fig. 5 and Supplementary Table S6). Future forecasts of AF /AFL burden attributed to high SBP in China As is shown in Fig. 6 , the ASDR of AF /AFL attributable to high SBP in China is anticipated to remain relatively stable, at approximately 26.96 per 100,000 people from 2022 to 2050, and the number of DALYs is expected to increase from 521,157.68 in 2022 to 1,292,976.11 by 2050 significantly. However, a different change trend is also observed between genders. In male, the ASDR is expected to rise from 26.28 per 100,000 in 2022 to 32.17 per 100,000 by 2050, with the number of DALYs increasing from 230,626.91 to 534,770.54. In contrast, the ASDR in female is expected to exhibit a slight downward trend, dropping from 26.82 per 100,000 in 2022 to 26.39 per 100,000 by 2050, even if the number of DALYs is expected to rise from 290,530.78 to 758,205.57. Discussion Hypertension is a significant risk factor for the occurrence of AF. 17 The proportion of individuals with AF and hypertension is as high as 60–80%, and hypertension significantly increases the risk of adverse cardiovascular events in the population with AF. 18 According to our research, the ASMR and ASDR levels in China are lower than the global average, however, the downward trend lines are not as steep as those in the global. There may be several reasons for this. In the Asia-Pacific cohort study, the association between elevated blood pressure and stroke or coronary events is stronger in Asian populations than in Australians and New Zealanders. 19 With each 10 mm Hg increase in systolic pressure, the risk of stroke and fatal myocardial infarction increases by 53% and 31% in Asians, respectively, while Australians and New Zealanders experience increases of 24% and 21%. 19 Another reason is the high sodium intake in China, which is a risk factor for hypertension. 20 The prevalence of hypertension in China continues to rise, and the control rate of high blood pressure has remained at a relatively low level, 21 which partially explains the less significant downward trend for the burden of AF/AFL in China than globally. Between 1990 and 2021, men have the most significant increase in ASMR and ASDR for AF/AFL attributable to high SBP in China, particularly in ASDR. According to a recent hypertension study in China, from 2010 to 2018, the absolute annual decline in prevalence of hypertension among women was more than twice that among men, 21 which might be a reason for the continuing increase of ASMR and ASDR in male and the downward trend in female. Additionally, in China, between 1991 and 2015, the rates of hypertension in the age groups of 60 to 79, 40 to 59, and 20 to 39 have risen by 25.1%, 87.4%, and 144.4%, respectively, 22 which indicates a pronounced upward trend in the prevalence of hypertension among young and middle-aged populations in China. Our APC results also reveal that the burden of AF/AFL in the middle-aged and young population is gradually increasing, especially in male. Furthermore, there are several other factors for explanation. Firstly, the incidence of hypertension is significantly higher among young male as compared to female. 23 , 24 Secondly, estrogen exerts a dual protective effect against hypertension and AF in young and middle-aged female. 25 , 26 Thirdly, there is a documented higher awareness, treatment rate, and control rate of hypertension in female than in male. 27 , 28 Finally, the initiation rate of oral anticoagulant therapy (OAC) in female patients has gradually increased. 29 Between 2017 and 2018, the rate of anticoagulation for hospitalized AF patients with a CHA2DS2-VASc score of 2 or more in 362 top-tier hospitals in China was 79.1%. 30 In recent years, the situation of anticoagulant treatment for AF patients with stroke in China has also improved, with the discharge anticoagulation rate increasing from 23.2% in 2015 to 47.1% in 2019. 31 In the China-AF cohort, the rate of anticoagulation within three months after discharge for non-valvular AF patients with acute ischemic stroke between 2011 and 2020 was 40%. 32 Altogether, all factors mentioned as above might be linked with a significant upward trend for the burden of AF/AFL attributable to high SBP in male, while a slight downward one in female. Based on the decomposition analysis from our study, the burden borne by elderly female remains relatively higher, which primarily due to the effects of population aging and the larger base size of the female demographic. The current findings are consistent with prior investigations. 33 The following factors may explain this phenomenon. Firstly, the female are more prone to comorbidities related to AF, and receive a lower rate of treatment. 25 Secondly, women tend to exhibit more symptoms of AF/AFL than men, 34 implying that high proportions of AF/AFL in men may go undetected. Thirdly, women have a generally longer lifespan and a larger base of elderly population than men. 35 According to the long-term Framingham Heart Study, aging is the primary risk factor for AF, surpassing all other factors. 36 Aging leads to not only degenerative changes at the molecular and tissue levels of the heart, causing the remodeling of atrial structure and electrophysiological characteristics, but also age-related diseases such as hypertension and heart failure, by intensifying cardiac fibrosis, further deepening the changes in myocardial structure. 37 Moreover, AF and its complications, including stroke and systemic embolism, may also, in turn, accelerate the aging process, 37 and a vicious circle ensues. The cohort and period analysis indicates that the ASDR has shown an overall upward trend. This phenomenon indirectly confirms that despite certain advancements in the prevention and management of hypertension, there remain insufficient areas. After 2004, the relative risk trend of the DALYs rate significantly weakened, in line with the widespread adoption of various national health initiatives to promote healthier lifestyles and reduce risks. 38 , 39 Furthermore, there has been a noted reduction in sodium consumption over the same timeframe. 40 In China, the PRR and CRR values in female have increased less, while the PRR and CRR values in male have significantly increased, indicating a continuing risk of DALYs due to AF/AFL in male. This could be linked to the worse effects of hypertension in male, and the beneficial impact of estrogen in female. 41 , 42 In the coming decades, due to the further worsening of the aging population in China, the burden of AF /AFL attributable to hypertension is projected to continue to rise. According to our predictive analysis, from 2022 to 2050, the number of DALYs of AF /AFL will continue to increase in both genders. Although the estimated ASDR for female in China shows a decreasing trend, the ASDR in male is still increasing, with a considerable number of new cases. Consequently, to preempt the health and economic burdens imposed by AF /AFL, China must intensify blood pressure control measures within the population, with particular emphasis on younger cohorts and male hypertensive patients. Although this study assessed the disease burden of AF /AFL attributable to high SBP in China using the GBD 2021 data, it has several limitations. Firstly, the underscreening of hypertension and AF /AFL in rural and underdeveloped areas may lead to an underestimation of patient numbers and an increased risk of misdiagnosis or missed diagnosis due to insufficient medical resources. Secondly, the study analyzed the ASMR and ASDR of AF /AFL attributable to high SBP in China from a macro perspective, revealing national-level temporal trends that may not accurately reflect individual-level conditions. Furthermore, the study only revealed the changing patterns of AF /AFL attributable to high SBP, while the impacts of other factors, such as high body mass index and smoking, on AF /AFL requires further investigation. Conclusion Our study reveals that in China, the disease burden of AF/AFL attributable to high SBP in male has been increasing between 1990 and 2021 and keeps an upward trend till 2050, with a slightly downward trend in female. The main driver of the increased DALY burden for AF /AFL attributed to high SBP is population aging. Based on the current findings, China should implement more comprehensive prevention strategies stratified by gender and age to alleviate the burden of AF/AFL attributable to high SBP, by promoting low-salt diets and healthy lifestyle management, enhancing awareness, treatment, and controlling rates of hypertension, and fully implementing the integrated management strategies. Declarations Data availability The datasets generated and analyzed in the current study are available at GBD 2021 website: https://ghdx.healthdata.org/gbd-results-tool. The code used and/or analysed during the current study are available from the corresponding author on reasonable request. Author contributions L.S.J. and B.H. designed the study. B.L. and X.Y.H. analyzed the data, performed statistical analyses, and drafted the initial manuscript. L.S.J. and B.H. checked and corrected the statistical analyses. J.W., Y.T.F., Q.S., L.S.J., and R.G.L. modified the initial manuscript. All authors reviewed the drafted manuscript for critical content and approved the final version of the manuscript. The corresponding authors (L.S.J. and B.H.) attest that all listed authors meet authorship criteria and that no others meeting the criteria have been omitted. Acknowledgements We extend our sincerely thanks to the contributors of the GBD 2021 and the Institute for Health Metrics and Evaluation (IHME) for their invaluable work. The study funders did not participate in the study's design, data collection, analysis, interpretation, or report writing. Funding This study was supported by the National Natural Science Foundation of China [grant number: 82170247] and a Three-year action plan project to promote clinical skills and clinical innovation ability of Shanghai Municipal Hospitals [grant number: SHDC2020CR1039B]. Competing interests The authors declare no competing interests. Consent for publication All participants in this study consented to publication. Additional information Supplementary Information The Supplementary Information can be available at Scientific Reports online. References Van Gelder, I. 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J Am Heart Assoc 6 , doi:10.1161/JAHA.117.006077 (2017). Olesen, J. B. et al. Validation of risk stratification schemes for predicting stroke and thromboembolism in patients with atrial fibrillation: nationwide cohort study. BMJ 342 , d124, doi:10.1136/bmj.d124 (2011). Nielsen, P. B., Brondum, R. F., Nohr, A. K., Overvad, T. F. & Lip, G. Y. H. Risk of stroke in male and female patients with atrial fibrillation in a nationwide cohort. Nat Commun 15 , 6728, doi:10.1038/s41467-024-51193-0 (2024). Zhao, Q. Y. et al. Contemporary characteristics, management, and outcomes of patients hospitalized for atrial fibrillation in China: results from the real-world study of Chinese atrial fibrillation registry. Chin Med J (Engl) 133 , 2883-2884, doi:10.1097/CM9.0000000000001151 (2020). Gu, H. Q. et al. Assessment of Trends in Guideline-Based Oral Anticoagulant Prescription for Patients With Ischemic Stroke and Atrial Fibrillation in China. JAMA Netw Open 4 , e2118816, doi:10.1001/jamanetworkopen.2021.18816 (2021). Wang, J. R. et al. Use of oral anticoagulants and its associated factors among nonvalvular atrial fibrillation patients with new-onset acute ischemic stroke: A report from the China Atrial Fibrillation Registry study. Clin Cardiol 45 , 60-67, doi:10.1002/clc.23759 (2022). Dong, X. J. et al. Global burden of atrial fibrillation/atrial flutter and its attributable risk factors from 1990 to 2019. Europace 25 , 793-803, doi:10.1093/europace/euac237 (2023). Dagres, N. et al. Gender-related differences in presentation, treatment, and outcome of patients with atrial fibrillation in Europe: a report from the Euro Heart Survey on Atrial Fibrillation. J Am Coll Cardiol 49 , 572-577, doi:10.1016/j.jacc.2006.10.047 (2007). Tian, X. T., Xu, Y. J. & Yang, Y. Q. Gender Differences in Arrhythmias: Focused on Atrial Fibrillation. J Cardiovasc Transl Res 13 , 85-96, doi:10.1007/s12265-019-09918-w (2020). Schnabel, R. B. et al. 50 year trends in atrial fibrillation prevalence, incidence, risk factors, and mortality in the Framingham Heart Study: a cohort study. Lancet 386 , 154-162, doi:10.1016/S0140-6736(14)61774-8 (2015). Gao, P., Gao, X., Xie, B., Tse, G. & Liu, T. Aging and atrial fibrillation: A vicious circle. Int J Cardiol 395 , 131445, doi:10.1016/j.ijcard.2023.131445 (2024). Hu, F. B., Liu, Y. & Willett, W. C. Preventing chronic diseases by promoting healthy diet and lifestyle: public policy implications for China. Obes Rev 12 , 552-559, doi:10.1111/j.1467-789X.2011.00863.x (2011). He, Y. et al. The dietary transition and its association with cardiometabolic mortality among Chinese adults, 1982-2012: a cross-sectional population-based study. Lancet Diabetes Endocrinol 7 , 540-548, doi:10.1016/S2213-8587(19)30152-4 (2019). Hipgrave, D. B., Chang, S., Li, X. & Wu, Y. Salt and Sodium Intake in China. JAMA 315 , 703-705, doi:10.1001/jama.2015.15816 (2016). Noh, B., McCullough, L. D. & Moruno-Manchon, J. F. Sex-biased autophagy as a potential mechanism mediating sex differences in ischemic stroke outcome. Neural Regen Res 18 , 31-37, doi:10.4103/1673-5374.340406 (2023). Ramirez, L. A. & Sullivan, J. C. Sex Differences in Hypertension: Where We Have Been and Where We Are Going. Am J Hypertens 31 , 1247-1254, doi:10.1093/ajh/hpy148 (2018). Additional Declarations No competing interests reported. Supplementary Files SupplementaryInformation.docx Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-5946566","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Article","associatedPublications":[],"authors":[{"id":411515079,"identity":"f821c3f7-001a-4038-804c-a8201bafa9e5","order_by":0,"name":"Bin Liu","email":"","orcid":"","institution":"Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine","correspondingAuthor":false,"prefix":"","firstName":"Bin","middleName":"","lastName":"Liu","suffix":""},{"id":411515080,"identity":"9a8f10f5-177d-42ea-9373-2601512e915e","order_by":1,"name":"Xiying Huang","email":"","orcid":"","institution":"Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine","correspondingAuthor":false,"prefix":"","firstName":"Xiying","middleName":"","lastName":"Huang","suffix":""},{"id":411515081,"identity":"37cde02c-ecf4-4c67-8c28-a78dd5d5b251","order_by":2,"name":"Ziyong Hao","email":"","orcid":"","institution":"Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine","correspondingAuthor":false,"prefix":"","firstName":"Ziyong","middleName":"","lastName":"Hao","suffix":""},{"id":411515082,"identity":"8afcdb68-bb9a-4f50-bb00-426cc5898d64","order_by":3,"name":"Jian Wang","email":"","orcid":"","institution":"Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine","correspondingAuthor":false,"prefix":"","firstName":"Jian","middleName":"","lastName":"Wang","suffix":""},{"id":411515083,"identity":"fa15c0e9-d677-4f5e-8e0d-cd2915c3aa33","order_by":4,"name":"Yiting Fan","email":"","orcid":"","institution":"Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine","correspondingAuthor":false,"prefix":"","firstName":"Yiting","middleName":"","lastName":"Fan","suffix":""},{"id":411515084,"identity":"da1d367b-a544-4576-bc74-ec3250b544bf","order_by":5,"name":"Qin Shao","email":"","orcid":"","institution":"Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine","correspondingAuthor":false,"prefix":"","firstName":"Qin","middleName":"","lastName":"Shao","suffix":""},{"id":411515085,"identity":"000fb505-3146-4d23-99ce-06084750ae0f","order_by":6,"name":"Ruogu Li","email":"","orcid":"","institution":"Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine","correspondingAuthor":false,"prefix":"","firstName":"Ruogu","middleName":"","lastName":"Li","suffix":""},{"id":411515086,"identity":"e1042cd6-eea9-42c9-9c6c-1162d955892c","order_by":7,"name":"Ben He","email":"","orcid":"","institution":"Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine","correspondingAuthor":false,"prefix":"","firstName":"Ben","middleName":"","lastName":"He","suffix":""},{"id":411515087,"identity":"524fc60e-98eb-4a95-8d85-2b0e572626b0","order_by":8,"name":"Lisheng Jiang","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA5UlEQVRIiWNgGAWjYBACxmYQyQZhPwZTzMwNxGnhAao1ZmAwAFKM+LVAAEQLmzRYCwMBLcztzM8efimzkbdn731WXVDxJ5q/HajlR8U2PA5jMzeWOZdm2MNz3Oz2jDMGuTMOMzYw9py5jc8vZtKSbYcTeCTS2G7zthnkNgC1MDO24dPC/g2upRikZT5hLTxmkh+hWphBWjYQoaVMmgHklzPHmKV5zhjnbgRqOYjPL4b9x7dJ/gCGGHt7G+Nnngq53HnnDx988KMCj5YGYEDzoIsewKkeCORBjvuBT8UoGAWjYBSMAgAZME/uIkbzGgAAAABJRU5ErkJggg==","orcid":"","institution":"Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine","correspondingAuthor":true,"prefix":"","firstName":"Lisheng","middleName":"","lastName":"Jiang","suffix":""}],"badges":[],"createdAt":"2025-02-02 16:08:10","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-5946566/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-5946566/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":75602023,"identity":"a75fb3c1-1c55-47d5-8bb2-3af70cfdf238","added_by":"auto","created_at":"2025-02-06 08:55:36","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":2018985,"visible":true,"origin":"","legend":"\u003cp\u003eChanging patterns of the numbers of deaths and DALYs for AF /AFL and their corresponding ASR attributable to high SBP in China and globally from 1990 to 2021. In the figure, the blue solid square dotted line represents females, the orange hollow circular line represents males, and the green hollow triangular dotted line represents both males and females. AF /AFL, atrial fibrillation /atrial flutter; SBP, systolic blood pressure; DALYs, disability-adjusted life years; ASR, age-standardized rate; ASMR, age-standardized mortality rate; ASDR, age-standardized DALY rate.\u003c/p\u003e","description":"","filename":"Figure1.png","url":"https://assets-eu.researchsquare.com/files/rs-5946566/v1/0a665f05331f71c0c8489c30.png"},{"id":75602024,"identity":"2df5f329-ceea-49a4-aa4e-5c76456e9fd0","added_by":"auto","created_at":"2025-02-06 08:55:36","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":267594,"visible":true,"origin":"","legend":"\u003cp\u003eEstimated annual percentage change (EAPC) of ASMR and ASDR for AF /AFL attributable to high SBP from 1990 to 2021 in China and globally. In the figure, the orange histogram represents males, the blue one represents females, and the green one represents both males and females. AF /AFL, atrial fibrillation /atrial flutter; SBP, systolic blood pressure; DALY, disability-adjusted life year; ASMR, age-standardized mortality rate; ASDR, age-standardized DALY rate; EAPC, estimated annual percentage change.\u003c/p\u003e","description":"","filename":"Figure2.png","url":"https://assets-eu.researchsquare.com/files/rs-5946566/v1/36f78e75970eb4e4c4718708.png"},{"id":75602034,"identity":"ce31e366-e5dd-4cb1-929f-5e5e92f17a79","added_by":"auto","created_at":"2025-02-06 08:55:37","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":1221359,"visible":true,"origin":"","legend":"\u003cp\u003eNet drift and local drift, age, period, and cohort effects on DALYs in AF /AFL attributable to high SBP in China from 1992 to 2021. In the figure, the blue dotted line represents males, the yellow one represents females, and the grey one represents both males and females. (A) Net drift and local drift on DALYs in AF /AFL attributable to high SBP in China by 14 age groups (30−34 to 95+ years), 1992−2021. The colored dashed lines and translucent ribbons represent the 95% CI of the net drift and the 95% CI of the local drift for the corresponding sex group, respectively. (B) Age effects are shown by the fitted longitudinal age curves of DALYs (per 100,000 person-years) adjusted for period deviations. (C) Period effects are shown by the relative risk of DALYs (DALYs rate ratio) and computed as the ratio of age-specific rates from 2002 to 2006 (the referent period) to 2017−2021. (D) Cohort effects are shown by the relative risk of DALYs and computed as the ratio of age-specific rates from the 1897 cohort to the 1987 cohort, with the referent cohort set at 1942. The dots and shaded areas denote DALYs rates or rate ratios and their corresponding 95% CIs.\u003c/p\u003e\n\u003cp\u003eAF /AFL, atrial fibrillation /atrial flutter; SBP, systolic blood pressure; DALY, disability-adjusted life year.\u003c/p\u003e","description":"","filename":"Figure3.png","url":"https://assets-eu.researchsquare.com/files/rs-5946566/v1/1e5d2d0755a83361b044bdfe.png"},{"id":75602519,"identity":"5ac6b551-b874-4b57-a6f0-1306e7d394ad","added_by":"auto","created_at":"2025-02-06 09:03:36","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":2934216,"visible":true,"origin":"","legend":"\u003cp\u003eChanging patterns of the disease burden according to the number of DALYs and the age-specific DALYs rate by sex and age in AF /AFL attributable to high SBP in China from 1990 to 2021. AF /AFL, atrial fibrillation /atrial flutter; SBP, systolic blood pressure; DALYs, disability-adjusted life years.\u003c/p\u003e","description":"","filename":"Figure4.png","url":"https://assets-eu.researchsquare.com/files/rs-5946566/v1/db7f62532fce82c8017d641f.png"},{"id":75602060,"identity":"b8693de0-f766-4379-9c21-4c28b1a87dfd","added_by":"auto","created_at":"2025-02-06 08:55:40","extension":"png","order_by":5,"title":"Figure 5","display":"","copyAsset":false,"role":"figure","size":145208,"visible":true,"origin":"","legend":"\u003cp\u003eDecomposition of DALYs for AF /AFL attributable to high SBP by sex according to aging, population, and epidemiological change from 1990 to 2021 in China. In the figure, the black dot represents the overall change value of population, aging, and epidemiological change. AF /AFL, atrial fibrillation /atrial flutter; SBP, systolic blood pressure; DALYs, disability-adjusted life years.\u003c/p\u003e","description":"","filename":"Figure5.png","url":"https://assets-eu.researchsquare.com/files/rs-5946566/v1/b4f3d8bf20d5fdd9cfd4431d.png"},{"id":75602026,"identity":"272655fe-9d7b-453c-9bce-27cfe7da8082","added_by":"auto","created_at":"2025-02-06 08:55:36","extension":"png","order_by":6,"title":"Figure 6","display":"","copyAsset":false,"role":"figure","size":1012713,"visible":true,"origin":"","legend":"\u003cp\u003ePredicted trends of the number of DALYs and its age-specific DALYs rate in AF /AFL attributable to high SBP by sex in China over the next 29 years (2022–2050). AF /AFL, atrial fibrillation /atrial flutter; SBP, systolic blood pressure; DALYs, disability-adjusted life years, ASDR, age-specific DALYs rate.\u003c/p\u003e","description":"","filename":"Figure6.png","url":"https://assets-eu.researchsquare.com/files/rs-5946566/v1/ea4d9d651c219fb467b6a397.png"},{"id":75696724,"identity":"5c3a16a6-3abb-4aaf-af6c-ee988f3f0bad","added_by":"auto","created_at":"2025-02-07 08:32:13","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":7795075,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5946566/v1/2733068a-b871-4a56-912b-7fbb06ffd15f.pdf"},{"id":75602518,"identity":"120e9960-fd64-4f3a-b9b8-027cd5f0372e","added_by":"auto","created_at":"2025-02-06 09:03:36","extension":"docx","order_by":2,"title":"","display":"","copyAsset":false,"role":"supplement","size":39886,"visible":true,"origin":"","legend":"","description":"","filename":"SupplementaryInformation.docx","url":"https://assets-eu.researchsquare.com/files/rs-5946566/v1/5f95a2964700e3aa186a40e5.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Changing patterns of the burden for atrial fibrillation /atrial flutter attributable to high systolic blood pressure in China From 1990 to 2021","fulltext":[{"header":"Introduction","content":"\u003cp\u003eAtrial fibrillation (AF) /atrial flutter (AFL) is the most prevalent form of cardiac arrhythmia, often leading to a series of complications, including stroke, thromboembolism, heart failure, and reducing patients' quality of life.\u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u003c/sup\u003e Data from the Global Burden of Disease (GBD) Study indicate that the disability-adjusted life years (DALYs) due to AF in the Chinese population have been on an upward trend annually, excluding the effect of age composition.\u003csup\u003e\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u003c/sup\u003e With the acceleration of China's aging population, it is anticipated that the disease burden of AF /AFL will further increase. A national survey conducted in 2021 reported that the prevalence of AF /AFL among Chinese adults is 1.6%.\u003csup\u003e3\u003c/sup\u003e As a result, AF /AFL remains a significant public health concern in China.\u003c/p\u003e \u003cp\u003eHypertension is a known risk factor for AF /AFL, with a 19% increase in the risk of AF /AFL for every 10 mmHg increase in systolic blood pressure(SBP).\u003csup\u003e\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u003c/sup\u003e Hypertension is not only the primary correlate of the cardiovascular disease burden in China but also the most significant modifiable factor.\u003csup\u003e\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e,\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u003c/sup\u003e Data from the Chinese National Stroke Screening and Prevention Project (CNSSPP) between 2014 and 2015 show that 26.6% of the risk of AF occurrence is attributed to hypertension.\u003csup\u003e\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u003c/sup\u003e To date, there are no studies to explore the changes in mortality and DALY rates due to AF /AFL related to high SBP in China. Therefore, it is imperative to assess the trend of the disease burden of AF /AFL attributable to high SBP in China.\u003c/p\u003e \u003cp\u003eIn this study, we utilized the age-standardized mortality rates (ASMR) and the age-standardized DALY rates (ASDR) from the Global Burden of Disease 2021 (GBD 2021) to explore the changing patterns of the disease burden of AF /AFL attributable to high SBP in China from 1990 to 2021 and the trend prediction in the next 30 years. Furthermore, we employed the age-period-cohort (APC) model to analyze the potential impacts of age, sexes, period, and cohort on the ASDR of AF /AFL.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003eThe GBD 2021 report utilizes the most recent epidemiological data and refined standardization methodologies to conduct a comprehensive assessment of the global burden of 371 diseases, injuries, and 88 risk factors across 204 countries and territories, stratified by age and sex.\u003csup\u003e\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e,\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u003c/sup\u003e In this study, the numbers of deaths and DALYs for AF /AFL and their corresponding age-standardized rates (ASR), with their 95% uncertainty interval (UI), are derived from the GBD 2021 data.\u003c/p\u003e \u003cp\u003eIn the GBD 2021 data, codes from the International Classification of Diseases (ICD-10) ranging from I48 to I48.9, as well as ICD-9 code 427.3, were used to identify AF/AFL. And, high SBP was defined as SBP above 110 to 115 mmHg.\u003csup\u003e\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003e \u003cstrong\u003eEthical approval and consent to participate\u003c/strong\u003e \u003cp\u003e The study was conducted in accordance with the Declaration of Helsinki (as revised in 2013). The study utilized the publicly available and free data, no patients were involved in the settings of research question or outcome measures, nor were they involved in the design or implementation of the study, so the agreement of the medical ethics committee board was not necessary.\u003c/p\u003e \u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStatistical analysis\u003c/h2\u003e \u003cdiv id=\"Sec4\" class=\"Section3\"\u003e \u003ch2\u003eDescriptive analysis\u003c/h2\u003e \u003cp\u003eBased on the latest -released GBD 2021 estimates, a comprehensive assessment was conducted to quantify the burden of AF /AFL attributable to high SBP, encompassing its mortality and DALYs rate at the global and Chinese levels. Furthermore, the study explored demographic factors affecting the burden of AF /AFL, by analyzing the disease's impact across various age groups and different genders.\u003c/p\u003e \u003cp\u003eThe ASMR and the ASDR for AF /AFL among males and females from 1990 to 2021 were visually represented in China and globally, with rates expressed per 100,000 population. Furthermore, the number of deaths and DALYs for AF /AFL and their corresponding ASRs for both genders were compared at the global and Chinese levels.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e\n\u003ch3\u003eTrend analysis\u003c/h3\u003e\n\u003cp\u003eTo assess the trend changes in the ASR and all age-specific rates over a defined period, this study calculated the estimated annual percentage changes (EAPC). A linear model was established by fitting a regression line to the natural logarithm of the ASR, expressed as y\u0026thinsp;=\u0026thinsp;α\u0026thinsp;+\u0026thinsp;βx, where y represents the natural logarithm of the ASR, and x represents the calendar year. The EAPC is determined using the formula EAPC\u0026thinsp;=\u0026thinsp;100% \u0026times; (exp(β) \u0026minus;\u0026thinsp;1). This model also allows for the 95% Confidence Interval (CI) computation.\u003csup\u003e\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u003c/sup\u003e If both the estimated EAPC and the lower bound of its 95% CI are positive, it suggests an increasing trend in the ASR. On the other hand, if both the estimated EAPC and the upper bound of its 95% CI are negative, it indicates a declining trend in the ASR. If there is an overlap in the 95% CI, the ASR is considered stable.\u003c/p\u003e\n\u003ch3\u003eDecomposition analysis\u003c/h3\u003e\n\u003cp\u003eThis study employs the decomposition method invented by Das Gupta to quantify the specific impacts of age structure, population growth, and epidemiological changes on the burden of AF /AFL attributable to high SBP.\u003csup\u003e\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e,\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e\n\u003ch3\u003eAPC model\u003c/h3\u003e\n\u003cp\u003eThe study conducted an age-period-cohort analysis to assess the individual influences of age, period, and cohort factors on DALYs rate of AF /AFL attributable to high SBP. This analysis dissected the three distinct trends and yielded more precise estimation outcomes.\u003csup\u003e\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eThe age effect indicates the physiological and societal aspects of the aging process. The period effect signifies the temporal shifts in DALYs of AF/AFL due to high SBP in all age groups. The cohort effect refers to changes from diverse risk factors and environmental influences experienced by a specific group of individuals (cohorts) over time.\u003csup\u003e\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eIn current research, we concentrated on estimating the net drift, the local drift, the longitudinal age curve, and the period and cohort rate ratios (RRs). Net drift signifies the aggregate logarithmic trend across different periods and birth cohorts, reflecting the general annual percentage alteration in the anticipated ASR as time progresses. Local drift is the average annual percentage change (AAPC) for each age group after accounting for period and birth cohort effects. The longitudinal age curve is the age-specific longitudinal rates adjusted for cohort and period effects. Lastly, the period (cohort) RRs represent the relative risk of a period (or cohort) compared to a reference period (or cohort), adjusted for age and non-linear cohort (or period) effects.\u003csup\u003e\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eIn conducting the age-period-cohort analysis, the study organized the data on the number of DALYs and population into sequential 5-year spans ranging from 1990 to 2021, and into consecutive 5-year age brackets starting from 30\u0026ndash;34 up to 95+. Given the challenge of dividing the data from 1990 and 1991 into full 5-year segments, a decision was made to omit these two years from the analysis. Because the DALY cases in those aged\u0026thinsp;\u0026lt;\u0026thinsp;30 years were rare in the GBD 2021 database, they were excluded from this study.\u003c/p\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eAutoregressive integrated moving average model\u003c/h2\u003e \u003cp\u003eThe Autoregressive Integrated Moving Average (ARIMA) model is a widely used statistical method for prediction of time series data in epidemiology.\u003csup\u003e\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u003c/sup\u003e In this study, we employed the R programming language to construct an ARIMA model, to forecast the burden of AF /AFL attributable to high SBP in China from 2022 to 2050.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec10\" class=\"Section2\"\u003e \u003ch2\u003eASMR and ASDR trends on AF /AFL attributable to high SBP in China and globally\u003c/h2\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e and Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e show the number of deaths and DALYs along with their corresponding ASRs in China and globally from 1990 to 2021, as well as the EAPC over the same period. Globally, the ASMR and ASDR for AF /AFL attributable to high SBP have shown a significant downward trend. Figure\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e depicts the trends in ASRs and the number of deaths and DALYs for AF /AFL attributable to high SBP in China and globally from 1990 to 2021. The global ASMR for AF /AFL attributable to high SBP decreases from 1.4 per 100,000 in 1990 to 1.3 per 100,000 in 2021, with an EAPC of -0.11 (95% CI, -0.15 to -0.07), and the ASDR decreases from 31.8 to 30.5, with an EAPC of -0.2 (95% CI, -0.23 to -0.17). In contrast, China's ASMR and ASDR for AF /AFL attributable to high SBP, although slightly lower than the global average, display different trends. Exactly, the ASMR is relatively stable, holding at about 1.3 per 100,000 population, with an EAPC of -0.17 (95% CI, -0.35 to 0.02), whereas the ASDR increases from 23.7 to 26.7 per 100,000 population, with an EAPC of 0.34 (95% CI, 0.22 to 0.46) (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e and Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eThe disease burden of the mortality for atrial fibrillation /atrial flutter attributable to high systolic blood pressure in China and the Global in 1990 and 2021.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"8\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eLocation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eSex\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e1990\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e2021\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003ePercentage\u003c/p\u003e \u003cp\u003echanges of\u003c/p\u003e \u003cp\u003eASR from 1990 to 2021\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e1990\u0026ndash;2021 EAPC (95% CI)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNo (95% UI)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eASR per 100,000 (95% UI)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eNo (95% UI)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eASR per 100,000 (95% UI)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eChina\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1277 (412,2269)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.8 (0.3,1.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e6466 (2085,11190)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.1 (0.4,1.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e30.2 (-15,125.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.96 (0.77,1.15)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3034 (1067,5605)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.5 (0.5,2.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e13121 (4460,23344)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.4 (0.5,2.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-7.5 (-41.8,50.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e-0.46 (-0.66, -0.27)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBoth\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4311 (1499,7497)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.3 (0.4,2.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e19587 (6868,32943)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.3 (0.5,2.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-0.8 (-31.9,47.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e-0.17 (-0.35,0.02)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eGlobal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e13155 (4707,21344)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.3 (0.5,2.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e39391 (14422,64872)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.3 (0.5,2.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.3 (-9.8,12.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.01 (-0.02,0.04)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e23699 (9086,37551)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.4 (0.5,2.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e64032 (22374,106403)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.3 (0.5,2.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-3.5 (-14.6,8.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e-0.17 (-0.22, -0.12)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBoth\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e36854 (13821,58446)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.4 (0.5,2.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e103423 (36820,170727)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.3 (0.5,2.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-2.3 (-11.4,6.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e-0.11 (-0.15, -0.07)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"8\"\u003eASR, age-standardized rate for mortality; 95% UI, 95% uncertainty interval; 95% CI, 95% confidence interval; EAPC, estimated annual percentage change.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eThe disease burden of the DALY for atrial fibrillation /atrial flutter attributable to high systolic blood pressure in China and the Global in 1990 and 2021.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"8\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eLocation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eSex\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e1990\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e2021\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003ePercentage\u003c/p\u003e \u003cp\u003echanges of ASR from 1990 to 2021\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e1990\u0026ndash;2021 EAPC (95% CI)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNo (95% UI)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eASR per 100,000 (95% UI)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eNo (95% UI)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eASR per 100,000 (95% UI)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eChina\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e51682 (16659,94267)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e19.4 (6.2,34.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e219765 (70786,385231)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e26 (8.4,44.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e33.9 (0.6,90.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1.13 (1,1.26)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e72639 (24440,129401)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e25.5 (8.7,45.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e273828 (88986,478055)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e26.5 (8.8,46.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e4.1 (-25.9,49.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e-0.04 (-0.17,0.09)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBoth\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e124321 (41104,218221)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e23.7 (7.9,41.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e493593 (166429,854027)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e26.7 (9.1,46.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e12.7 (-12.8,49.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.34 (0.22,0.46)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eGlobal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e474123 (158341,789987)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e33.5 (11.2,55.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1175342 (392021,1988353)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e32.6 (10.8,55.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-2.6 (-9.3,5.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e-0.09 (-0.1, -0.08)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e575205 (203721,929976)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e30.1 (10.7,48.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1339240 (448977,2216431)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e28.5 (9.6,47.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-5.2 (-12.9,3.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e-0.29 (-0.34, -0.25)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBoth\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1049327 (362165,1717378)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e31.8 (11,51.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2514582 (849855,4226734)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e30.5 (10.3,51.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-3.9 (-10.2,2.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e-0.2 (-0.23, -0.17)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"8\"\u003eASR, age-standardized rate for DALY; DALY, disability-adjusted life year; 95% UI, 95% uncertainty interval; 95% CI, 95% confidence interval; EAPC, estimated annual percentage change.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eIn terms of gender differences, from 1990 to 2021, the EAPC values for ASMR and ASDR in female are both under zero, which are lower than those in male both in China and globally, indicating a declining trend in female in the disease burden of AF/AFL attributable to high SBP. However, in China, the EAPC values for ASMR and ASDR in male are both over zero, reflecting an ascending trend since 1990 (See Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e, Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e, Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e, and Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). As described in Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e, between 1990 and 2021, the number of deaths and DALYs and their corresponding ASRs in female caused by AF /AFL attributable to high SBP has been significantly higher than in male in China and globally. It is worth noting that before 2013, the ASDR in Chinese female was significantly higher than in male, but it presents a downward trend and maintains a similar level to that in male since 2013.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eNet drift and local drift in different age groups\u003c/h2\u003e \u003cp\u003eIn this study, the local and net drifts on DALYs were calculated and analyzed using the APC model, and the results are presented in Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003eA and the Supplementary Table \u003cspan refid=\"MOESM1\" class=\"InternalRef\"\u003eS1\u003c/span\u003e. The colored horizontal dashed lines in the figure represent the net drift for each group, while the solid lines depict the local drift. The net drift for ASDR is \u0026gt;\u0026thinsp;0 in all groups, suggesting that their ASDR has an upward trend after adjusting for the period and cohort from 1992 to 2021. The local drift curve in male exhibits a U-shape and intersects with the net drift curve at two points, implying the proportion in male in the age groups before 65 to 70 years and those above 95 years is on an upward. The local drift curve in female descends with age and intersects with the net drift curve near 65 to 70 years, reflecting the disease burden of AF/AFL in female tends to decrease in the elderly population. The EAPC in DALYs for various age groups in China from 1992 to 2021 was presented in Supplementary Table S2, with results similar to those observed in the local drift analysis.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eAPC effects on AF /AFL\u003c/h2\u003e \u003cp\u003eThe longitudinal age curves of the AF /AFL attributable to high SBP in China is illustrated in Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003eB. The results found that the DALYs rate for AF /AFL increases significantly with age in both genders. The DALYs rate per 100,000 people increases from 0.07 in the 30 to 35-year-old age group to 2280.1 in the 95\u0026thinsp;+\u0026thinsp;years old age group. Figures\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003eC and Figs.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003eD present the period rate ratio (PRR) and cohort rate ratio (CRR) of DALY for AF /AFL attributable to high SBP in China, respectively. Before 2002 to 2007, the risk in female was always higher than that in male, but after 2002 to 2007, the risk in male has been significantly higher than in female. It is noteworthy that the increasing trends of period effects in male are more pronounced than in female. The CRR for AF /AFL has increased in both genders, indicating a general rise in relative risk for both sexes. In patients born before 1942, the relative risk in female is generally higher than in male, however, born after 1942, there is a significant rise in the relative risk in male, which exceeded that in female.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003eAge and sex patterns\u003c/h2\u003e \u003cp\u003eThe DALYs for various age groups in China from 1990 to 2021, along with the corresponding rates, were displayed in Supplementary Table S3, Table S4, and Table S5.\u003c/p\u003e \u003cp\u003eAs described in Fig.\u0026nbsp;\u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e4\u003c/span\u003e, from 1990 to 2021, the DALYs rate has exhibited a continuous upward trend with age, and the elderly are the main contributors to the increased number of DALYs. For male, the DALYs rate over 90 shows a significant upward trend starting from 2002, while for female, the trend is slightly downward since 2003. In contrast, the DALYs rate is relatively stable in other age groups among both genders.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003eDecomposition analysis\u003c/h2\u003e \u003cp\u003eDecomposition analysis indicates that from 1990 to 2021, the burden of AF /AFL attributable to high SBP in China, as measured by DALYs, has significantly increased. In the past 32 years, the number of DALYs in China has increased by 1756812.54 (a 1413.13% increase than in 1990), with 1077162.56 in male (a 2084.20% increase), and 836634.87 in female (a 1151.78% increase). The increase in the burden of AF /AFL attributable to high SBP in China, is primarily driven by aging. Over the past 32 years, the aging factor has led to a 71.95% increase in DALYs, with an 81.82% increase in female and a 43.34% increase in male driven by aging, respectively (Fig.\u0026nbsp;\u003cspan refid=\"Fig5\" class=\"InternalRef\"\u003e5\u003c/span\u003e and Supplementary Table S6).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec15\" class=\"Section2\"\u003e \u003ch2\u003eFuture forecasts of AF /AFL burden attributed to high SBP in China\u003c/h2\u003e \u003cp\u003eAs is shown in Fig.\u0026nbsp;\u003cspan refid=\"Fig6\" class=\"InternalRef\"\u003e6\u003c/span\u003e, the ASDR of AF /AFL attributable to high SBP in China is anticipated to remain relatively stable, at approximately 26.96 per 100,000 people from 2022 to 2050, and the number of DALYs is expected to increase from 521,157.68 in 2022 to 1,292,976.11 by 2050 significantly. However, a different change trend is also observed between genders. In male, the ASDR is expected to rise from 26.28 per 100,000 in 2022 to 32.17 per 100,000 by 2050, with the number of DALYs increasing from 230,626.91 to 534,770.54. In contrast, the ASDR in female is expected to exhibit a slight downward trend, dropping from 26.82 per 100,000 in 2022 to 26.39 per 100,000 by 2050, even if the number of DALYs is expected to rise from 290,530.78 to 758,205.57.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eHypertension is a significant risk factor for the occurrence of AF.\u003csup\u003e\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e\u003c/sup\u003e The proportion of individuals with AF and hypertension is as high as 60\u0026ndash;80%, and hypertension significantly increases the risk of adverse cardiovascular events in the population with AF.\u003csup\u003e\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e\u003c/sup\u003e According to our research, the ASMR and ASDR levels in China are lower than the global average, however, the downward trend lines are not as steep as those in the global. There may be several reasons for this. In the Asia-Pacific cohort study, the association between elevated blood pressure and stroke or coronary events is stronger in Asian populations than in Australians and New Zealanders.\u003csup\u003e\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e\u003c/sup\u003e With each 10 mm Hg increase in systolic pressure, the risk of stroke and fatal myocardial infarction increases by 53% and 31% in Asians, respectively, while Australians and New Zealanders experience increases of 24% and 21%.\u003csup\u003e19\u003c/sup\u003e Another reason is the high sodium intake in China, which is a risk factor for hypertension.\u003csup\u003e\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e\u003c/sup\u003e The prevalence of hypertension in China continues to rise, and the control rate of high blood pressure has remained at a relatively low level,\u003csup\u003e\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e\u003c/sup\u003e which partially explains the less significant downward trend for the burden of AF/AFL in China than globally.\u003c/p\u003e \u003cp\u003eBetween 1990 and 2021, men have the most significant increase in ASMR and ASDR for AF/AFL attributable to high SBP in China, particularly in ASDR. According to a recent hypertension study in China, from 2010 to 2018, the absolute annual decline in prevalence of hypertension among women was more than twice that among men,\u003csup\u003e\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e\u003c/sup\u003e which might be a reason for the continuing increase of ASMR and ASDR in male and the downward trend in female. Additionally, in China, between 1991 and 2015, the rates of hypertension in the age groups of 60 to 79, 40 to 59, and 20 to 39 have risen by 25.1%, 87.4%, and 144.4%, respectively,\u003csup\u003e\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e\u003c/sup\u003e which indicates a pronounced upward trend in the prevalence of hypertension among young and middle-aged populations in China. Our APC results also reveal that the burden of AF/AFL in the middle-aged and young population is gradually increasing, especially in male. Furthermore, there are several other factors for explanation. Firstly, the incidence of hypertension is significantly higher among young male as compared to female.\u003csup\u003e\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e,\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e\u003c/sup\u003e Secondly, estrogen exerts a dual protective effect against hypertension and AF in young and middle-aged female.\u003csup\u003e\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e,\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e\u003c/sup\u003e Thirdly, there is a documented higher awareness, treatment rate, and control rate of hypertension in female than in male.\u003csup\u003e\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e,\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e\u003c/sup\u003e Finally, the initiation rate of oral anticoagulant therapy (OAC) in female patients has gradually increased.\u003csup\u003e\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e\u003c/sup\u003e Between 2017 and 2018, the rate of anticoagulation for hospitalized AF patients with a CHA2DS2-VASc score of 2 or more in 362 top-tier hospitals in China was 79.1%.\u003csup\u003e30\u003c/sup\u003e In recent years, the situation of anticoagulant treatment for AF patients with stroke in China has also improved, with the discharge anticoagulation rate increasing from 23.2% in 2015 to 47.1% in 2019.\u003csup\u003e\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e\u003c/sup\u003e In the China-AF cohort, the rate of anticoagulation within three months after discharge for non-valvular AF patients with acute ischemic stroke between 2011 and 2020 was 40%.\u003csup\u003e32\u003c/sup\u003e Altogether, all factors mentioned as above might be linked with a significant upward trend for the burden of AF/AFL attributable to high SBP in male, while a slight downward one in female.\u003c/p\u003e \u003cp\u003eBased on the decomposition analysis from our study, the burden borne by elderly female remains relatively higher, which primarily due to the effects of population aging and the larger base size of the female demographic. The current findings are consistent with prior investigations.\u003csup\u003e\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e\u003c/sup\u003e The following factors may explain this phenomenon. Firstly, the female are more prone to comorbidities related to AF, and receive a lower rate of treatment.\u003csup\u003e\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e\u003c/sup\u003e Secondly, women tend to exhibit more symptoms of AF/AFL than men,\u003csup\u003e\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e\u003c/sup\u003e implying that high proportions of AF/AFL in men may go undetected. Thirdly, women have a generally longer lifespan and a larger base of elderly population than men.\u003csup\u003e\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e\u003c/sup\u003e According to the long-term Framingham Heart Study, aging is the primary risk factor for AF, surpassing all other factors.\u003csup\u003e\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e\u003c/sup\u003e Aging leads to not only degenerative changes at the molecular and tissue levels of the heart, causing the remodeling of atrial structure and electrophysiological characteristics, but also age-related diseases such as hypertension and heart failure, by intensifying cardiac fibrosis, further deepening the changes in myocardial structure.\u003csup\u003e\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e\u003c/sup\u003e Moreover, AF and its complications, including stroke and systemic embolism, may also, in turn, accelerate the aging process,\u003csup\u003e\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e\u003c/sup\u003e and a vicious circle ensues.\u003c/p\u003e \u003cp\u003eThe cohort and period analysis indicates that the ASDR has shown an overall upward trend. This phenomenon indirectly confirms that despite certain advancements in the prevention and management of hypertension, there remain insufficient areas. After 2004, the relative risk trend of the DALYs rate significantly weakened, in line with the widespread adoption of various national health initiatives to promote healthier lifestyles and reduce risks.\u003csup\u003e\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e,\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e\u003c/sup\u003e Furthermore, there has been a noted reduction in sodium consumption over the same timeframe.\u003csup\u003e\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e\u003c/sup\u003e In China, the PRR and CRR values in female have increased less, while the PRR and CRR values in male have significantly increased, indicating a continuing risk of DALYs due to AF/AFL in male. This could be linked to the worse effects of hypertension in male, and the beneficial impact of estrogen in female.\u003csup\u003e\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e,\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eIn the coming decades, due to the further worsening of the aging population in China, the burden of AF /AFL attributable to hypertension is projected to continue to rise. According to our predictive analysis, from 2022 to 2050, the number of DALYs of AF /AFL will continue to increase in both genders. Although the estimated ASDR for female in China shows a decreasing trend, the ASDR in male is still increasing, with a considerable number of new cases. Consequently, to preempt the health and economic burdens imposed by AF /AFL, China must intensify blood pressure control measures within the population, with particular emphasis on younger cohorts and male hypertensive patients.\u003c/p\u003e \u003cp\u003eAlthough this study assessed the disease burden of AF /AFL attributable to high SBP in China using the GBD 2021 data, it has several limitations. Firstly, the underscreening of hypertension and AF /AFL in rural and underdeveloped areas may lead to an underestimation of patient numbers and an increased risk of misdiagnosis or missed diagnosis due to insufficient medical resources. Secondly, the study analyzed the ASMR and ASDR of AF /AFL attributable to high SBP in China from a macro perspective, revealing national-level temporal trends that may not accurately reflect individual-level conditions. Furthermore, the study only revealed the changing patterns of AF /AFL attributable to high SBP, while the impacts of other factors, such as high body mass index and smoking, on AF /AFL requires further investigation.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eOur study reveals that in China, the disease burden of AF/AFL attributable to high SBP in male has been increasing between 1990 and 2021 and keeps an upward trend till 2050, with a slightly downward trend in female. The main driver of the increased DALY burden for AF /AFL attributed to high SBP is population aging. Based on the current findings, China should implement more comprehensive prevention strategies stratified by gender and age to alleviate the burden of AF/AFL attributable to high SBP, by promoting low-salt diets and healthy lifestyle management, enhancing awareness, treatment, and controlling rates of hypertension, and fully implementing the integrated management strategies.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eData availability\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets generated and analyzed in the current study are available at GBD 2021 website: https://ghdx.healthdata.org/gbd-results-tool. The code used and/or analysed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eAuthor contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003eL.S.J. and B.H. designed the study. B.L. and X.Y.H. analyzed the data, performed statistical analyses, and drafted the initial manuscript. L.S.J. and B.H. checked and corrected the statistical analyses. J.W., Y.T.F., Q.S., L.S.J., and R.G.L. modified the initial manuscript. All authors reviewed the drafted manuscript for critical content and approved the final version of the manuscript. The corresponding authors (L.S.J. and B.H.) attest that all listed authors meet authorship criteria and that no others meeting the criteria have been omitted.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe extend our sincerely thanks to the contributors of the GBD 2021 and the Institute for Health Metrics and Evaluation (IHME) for their invaluable work. The study funders did not participate in the study\u0026apos;s design, data collection, analysis, interpretation, or report writing.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was supported by the National Natural Science Foundation of China [grant number: 82170247] and a Three-year action plan project to promote clinical skills and clinical innovation ability of Shanghai Municipal Hospitals [grant number: SHDC2020CR1039B].\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll participants in this study consented to publication.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAdditional information\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSupplementary Information\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe Supplementary Information can be available at \u003cem\u003eScientific Reports\u003c/em\u003e online.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eVan Gelder, I. 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Sex Differences in Hypertension: Where We Have Been and Where We Are Going. \u003cem\u003eAm J Hypertens\u003c/em\u003e \u003cstrong\u003e31\u003c/strong\u003e, 1247-1254, doi:10.1093/ajh/hpy148 (2018).\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Systolic blood pressure, Global burden of disease, Atrial fibrillation, Disability-adjusted life years, Epidemiology","lastPublishedDoi":"10.21203/rs.3.rs-5946566/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5946566/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eThis study aims to investigate the changing patterns of the burden for atrial fibrillation (AF) /atrial flutter (AFL) attributed to high systolic blood pressure (SBP) in China. Data were sourced from the Global Burden of Disease (GBD) 2021 project. The disease burden of AF /AFL attributed to high SBP in China from 1990 to 2021 was analyzed stratified by sex and age, along with the trend prediction from 2022 to 2050. In China, between 1990 and 2021, the age-standardized mortality rate (ASMR) and the age-standardized disability-adjusted life years (DALYs) rate (ASDR) of AF/AFL attributable to high SBP in male have been increasing, and the trend will continue till 2050, whereas in female, the trend is slightly downward. Globally, however, the disease burden according to the estimated annual percentage changes (EAPC) of ASMR and ASDR presents a deducing trend in both genders between 1990 and 2021. The main driver of the increased DALY burden for AF /AFL attributed to high SBP is population aging. In China, the disease burden of AF/AFL attributable to high SBP in male has been increasing between 1990 and 2021 and keeps an upward trend till 2050, whereas in female, the trend is slightly downward. Our research implies that the public health decision-making needs to give sufficient attention to alleviate the burden of AF /AFL attributable to high SBP in China by promoting awareness, treatment, and controlling rates of hypertension, especially in male.\u003c/p\u003e","manuscriptTitle":"Changing patterns of the burden for atrial fibrillation /atrial flutter attributable to high systolic blood pressure in China From 1990 to 2021","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-02-06 08:55:32","doi":"10.21203/rs.3.rs-5946566/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"63e83475-a8cc-4deb-b4c5-7db5de33ae47","owner":[],"postedDate":"February 6th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-02-07T08:23:53+00:00","versionOfRecord":[],"versionCreatedAt":"2025-02-06 08:55:32","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-5946566","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5946566","identity":"rs-5946566","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}