Abstract 4361671: Substance Use Disorder and Atrial Fibrillation–Related Mortality Trends and Disparities Among Adults Aged ≥ 25 Years in the United States from 1999–2020: A CDC WONDER Database Analysis

Abstract

Introduction: Substance abuse disorder (SUD) combined with atrial fibrillation (AF) results in dire patient outcomes and accelerated mortality. Research on the combined mortality trends and disparities, stratified by different demographic and geographical classifications related to substance use disorders (SUD) and alcohol-related fatalities (AF), is limited. This study examines mortality trends in adults aged 25 years and older with SUD and AF from 1999 to 2020. Methods: The CDC WONDER Multiple Cause-of-Death dataset from 1999 to 2020 was used to analyze mortality trends among adults aged 25 years and older, using ICD-10 codes F10-F19 for SUD and I48 for AF. Age-adjusted mortality rates (AAMR) were quantified per 100,000 (95% CI). Ten-year age groups were used in the data extraction. Average annual percent change (AAPC) in terms of AAMR was analyzed using the Joinpoint regression model, and statistical significance was set at p<0.05. Results: Between 1999 and 2020, 253,949 SUD- and AF-related deaths occurred, mostly in nursing homes/long-term care facilities (41.6%). Overall, AAMR rose from 0.5 in 1999 to 10.5 in 2020 (AAPC: 17.1; 95% CI: 16.0 to 20.0). Men had a higher AAMR compared to women (men: 8.1 vs. women: 3.4), though both sexes had similar rates of increase (AAPC men: 16.8; 95% CI: 15.8 to 20.1 vs. women: 16.8; 95% CI: 15.7 to 18.9). AAMR increased with age, as adults aged ≥ 75 years had the highest AAMR (38.6) compared to 55-74-year-olds (6.8) and 25-54-year-olds (0.2). Adults aged ≥ 75 years also had the highest rate of increase (AAPC: 18.2; 95% CI: 17.1 to 21.3). Non-Hispanic (NH) Whites had a higher AAMR (6.1) compared to NH Black/African Americans (3.0), along with a higher rate of increase (AAPC: 17.6; 95% CI: 16.6 to 20.4). Regionally, the Midwest had the highest AAMR (6.8), along with the highest rate of increase (AAPC: 18.1; 95% CI: 17.2 to 20.2). State-wise, AAMR extended from 1.0 in California to 16.1 in Vermont. Non-metropolitan areas had a higher AAMR (7.2) versus metropolitan areas (5.0), along with a higher rate of increase (AAPC: 18.8; 95% CI: 17.8 to 20.9). Conclusion: SUD- and AF-related mortality in adults ≥ 25 years old increased from 1999 to 2020, along with significant disparities among demographic and regional stratifications. These disparities emphasize the need for targeted prevention and support strategies for at-risk communities to achieve equitable access to health care so that mortality rates can decrease in the future.