S1388 Trends and Disparities in Mortality Among Older Adults With Atrial Fibrillation and Gastrointestinal Bleeding in the United States, 1999–2020

Introduction: Atrial fibrillation (AF), a common cardiac arrhythmia, is linked to a heightened risk of gastrointestinal (GI) bleeding, especially in patients on anticoagulation therapy. This study examines trends in AF and GI bleeding-related mortality in older adults in the United States from 1999 to 2020, focusing on variations by demographic and geographic factors. Methods: We examined death certificates sourced from the CDC WONDER (Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research) database from 1999 to 2020. We analyzed mortality among adults aged ≥65 years where AF and GI bleeding were recorded as underlying or contributing causes of death. Age-adjusted mortality rates (AAMRs) per 100,000 persons were calculated, and Joinpoint regression was used to assess trends, annual percentage change (APC), and average annual percentage change (AAPC) stratified by year, gender, race, and geographic region. Results: A total of 55,121 deaths associated with AF and GI bleeding were recorded, with 24,944 deaths occurring in men and 30,177 in women. The overall AAMR increased from 4.47 in 1999 to 9.22 in 2020 (AAPC: 2.76 [95% CI: 2.36 to 3.22]), with a steady rise from 1999 to 2010 (APC: 0.46 [95% CI: -1.13 to 1.53]), followed by a sharp increase in 2020 (APC: 5.36 [95% CI: 4.45 to 6.85]). Males had a higher AAMR (7.09) than women (5.19). Among racial and ethnic groups, the Non-Hispanic (NH) White population had the highest AAMR (6.41), followed by NH American Indian or Alaska Natives (5), NH Black Americans (4.46), NH Asian or Pacific Islanders (3.73), and the Hispanic or Latino population (3.33). Nonmetropolitan areas showed higher AAMRs (6.91) compared to metropolitan areas (5.76). The Northeast region had the highest AAMR (6.44) among U.S. Census Regions. States in the top 90th percentile for AAMRs included Vermont, Rhode Island, Washington, West Virginia, and South Dakota, with Vermont having the highest AAMR (12.68) and Louisiana the lowest (2.81). Conclusion: Mortality rates among older adults with AF and GI bleeding are increasing in the U.S. population. These findings highlight the need for targeted interventions to address disparities in high-risk groups and regions.