Trends and Disparities in Stroke-Related Mortality among Patients with Atrial Fibrillation in the United States: A CDC-WONDER Analysis, 1999–2024

Abstract

Background & Objective: Atrial fibrillation (AF) is a major risk factor associated with stroke and strongly influences cardiovascular mortality. Our study aims to measure changes in mortality in patients with AF and stroke from 1999 to 2024 and assess gaps according to demographic and geographic groups. Methodology: We retrospectively observed age-adjusted mortality rates associated with stroke among patients with AF from 1999-2024 using the Centers for Disease Control and Prevention Wide-ranging Online Data for Epidemiologic Research (CDC WONDER) database. Temporal trends were observed, and annual percent change (APC) was calculated using jointpoint regression. Results: Overall, there is a drop in stroke-related mortality in patients with AF from 1999–2024 (AAPC: −0.65%; p<0.001). Females present an increased decline than males comparatively (AAPC: −0.97% vs −0.12%). While Black/African Americans revealed an elevated trend (AAPC: +0.86%; p<0.001), all other races showed a notable decline. Age groups showed an overall drop (AAPC: −1.13%; p<0.001) in 65+ adults’ ages, a rapid reduction in 2021-2024 (APC: −7.50%) following an upward trend throughout the period of 2018–2021 (APC: +3.69%). On the other hand, 45-64 years showed that there is an overall increase (AAPC: +3.15%; p<0.001) that reached its highest in 2018–2021 (APC: +14.86%) followed by a drop. All census regions revealed a decline in mortality; the northeast shows a maximum decline (AAPC: −1.28%). Non-metropolitan areas experienced an elevated trend (AAPC: +0.67%; p<0.001), whereas metropolitan areas persisted at a steady rate. A widespread drop is observed in demographic groups recently. Conclusion: Despite the fact that there is a decreased stroke-associated mortality among patients with AF over the recent 25 years in the United States, continued racial and geographic inequalities remain. Specific preventive measures, equitable access to stroke prevention therapies, and improved cardiovascular care are needed to decrease these gaps. Key Words: Atrial Fibrillation, Stroke, Mortality.