Emerging trends and disparities in mortality due to coexisting atrial fibrillation and sepsis: A US nationwide observational study (1999-2023).

A total of 240,222 deaths in the US involved both AF/atrial flutter and sepsis as listed causes between 1999 and 2023.

• Data were drawn from US death certificates in the CDC Wide-Ranging Online Data for Epidemiologic Research (WONDER) database.
• The study included individuals aged ≥25 years who died between 1999 and 2023.
• Both sepsis and AF/atrial flutter had to be listed as causes of death for inclusion.

The overall age-adjusted mortality rate (AAMR) for coexisting AF and sepsis increased substantially from 1999 to 2021, followed by a slight decline.

• AAMR increased from 2.0 per 100,000 in 1999 to a peak of 7.9 per 100,000 in 2021.
• Annual percent change (APC) was +5.6% through 2018, accelerating to +12.6% through 2021.
• A slight decline to 7.1 per 100,000 was observed by 2023.

Mortality due to coexisting AF and sepsis was consistently higher in men than in women across the study period.

• Sex-based disparities were observed across the full 1999–2023 timeframe.
• Age-adjusted mortality rates were stratified by sex as part of the demographic analysis.
• This finding was consistent across years analyzed.

Older adults had consistently higher mortality rates from coexisting AF and sepsis compared to younger age groups.

• Age group was one of the stratification variables used in demographic analysis.
• The population studied was aged ≥25 years, with age-adjusted mortality rates calculated to account for age distribution differences.
• Age was identified as a persistent disparity factor throughout the study period.

Non-Hispanic White and non-Hispanic Black individuals had the highest AAMRs for coexisting AF and sepsis among racial/ethnic groups.

• AAMRs by race/ethnicity ranked as follows: non-Hispanic White and Black highest, followed by American Indian/Alaska Native, Hispanic, and Asian/Pacific Islander populations.
• Race/ethnicity was one of six demographic stratification variables analyzed.
• Racial/ethnic disparities persisted across the study period from 1999 to 2023.

Residents of nonmetropolitan areas had higher mortality rates from coexisting AF and sepsis than metropolitan residents.

• Urbanization status was used as a stratification variable in the analysis.
• Nonmetropolitan area residents showed consistently higher AAMRs throughout the study period.
• This finding was cited as evidence for the need for enhanced access to critical care in underserved regions.

The US South had the highest regional mortality rates for coexisting AF and sepsis compared to other geographic regions.

• Geographic region was one of six demographic stratification variables analyzed.
• The South was identified as the region with the highest AAMRs among US geographic regions.
• Regional disparities persisted across the full study period.

The rate of increase in AAMR accelerated markedly in the period leading up to 2021 compared to earlier years.

• APC was +5.6% per year through 2018.
• APC accelerated to +12.6% per year through 2021.
• The peak AAMR of 7.9 per 100,000 was reached in 2021, representing a more than threefold increase from the 1999 baseline of 2.0.