Mortality Trends in Atrial Fibrillation and Renal Failure Among Older US Adults: A 25-Year Retrospective Analysis (1999–2024)

A well-established relationship exists between renal failure (RF), particularly chronic kidney disease, and atrial fibrillation (AF), as each condition can exacerbate the other. AF is observed with greater frequency in individuals with chronic kidney disease in the United States. This study investigates mortality trends associated with AF and RF from 1999 to 2024, concentrating on gender, racial, and regional disparities. We analyzed mortality data from the Centers for Disease Control and Prevention's Wide-ranging Online Data for Epidemiologic Research database, focusing on deaths where AF and RF contributed. Age-adjusted mortality rates (AAMRs) were calculated and stratified by sex, race/ethnicity, state, and region. The annual percentage change (APC) and average APC were estimated using the Joinpoint regression method. A total of 394,882 deaths related to AF and RF have been recorded, with the overall AAMR increasing from 16.6 in 1999 to 52.8 in 2023. Mortality rates experienced a significant increase from 1999 to 2012 (APC, 6.1%; P = 0.003), followed by a decrease from 2012 to 2015 (APC, -8.04%; P = 0.003), and then a resurgence from 2015 to 2024 (APC, 7.89%; P < 0.001). Males consistently exhibited higher AAMR than females (43.43 vs 27.01), as did non-Hispanic White individuals in comparison to other racial groups. Geographic disparities indicated higher mortality rates in urban areas and the Midwest. There has been a significant increase in mortalities associated with AF and RF among older adults (aged ≥65 years). Notably, recent surges have been observed in Colorado, Minnesota, and South Dakota, underscoring the necessity for targeted public health interventions.