In this study, data derived from the Global Burden of Disease Study 2019 (GBD 2019) were utilized to thoroughly assess the burden of AF/AFL in individuals aged 25–49 years globally, and to ascertain the trend changes over the past three decades. Premature AF/AFL is associated with severe consequences. As the most common persistent arrhythmia, its prevalence is on the rise in Western countries [13]. AF/AFL escalates the risk of future cardiovascular and cerebrovascular diseases, leading to adverse outcomes [14–17]. In 2013, emerging economies such as China and India reinforced their political commitment to the prevention and control of noncommunicable diseases, including AF/AFL, with the objective of reducing premature deaths caused by cardiovascular diseases (CVD) [18, 19]. In the present work, the AF/AFL burden in young people from China and India improved to a certain extent, and the ranks of prevalence, mortality and DALYs decreased slightly, regardless of the great absolute burden. Pacific island countries such as Nauru, the Marshall Islands and the Marshall Islands have shown high AF-AFL-related mortality and DALY rates in young people, regardless of the small population base. Because of the restrictions on land area, dispersion in locations, and distance from global social and economic activity centers, these countries are experiencing difficulties in the development of basic healthcare facilities. In 2013, the United Nations took action to reduce biological and behavioral risks to decrease CVD mortality by 25% by 2025. Additionally, they formulated a roadmap in 2021 to implement the Global Action Plan for the Prevention and Control of Noncommunicable Diseases 2023–2030 [20, 21]. Obviously, the above Pacific Island countries with low income levels require further global assistance and coordination. Strikingly, the United States has also experienced demographic changes and air pollution, despite its extremely large absolute and relative burdens on prevalence and incidence [22, 23]. Prevention and treatment of young AF/AFL patients are also crucial public health issues encountered by the US government and health sector.
AF/AFL requires surgical treatment or long-term medication, which may induce functional impairment and economic hardship in survivors and is associated with high disease relapse risk and dismal prognostic outcome, thereby posing substantial burdens on both patients and their families [2, 24–26]. At present, the incidence, prevalence, and trends of AF/AFL have rarely been reported. In several studies with small sample sizes, the AF/AFL ratio increased slightly or was stable among young people in several countries [27–30]. In summary, the incidence of AF/AFL increases or is stable among people aged < 50 years, but this trend is accelerating among elderly patients, as reported in certain studies [31]. The present work comprehensively analyzed the long-term trends in AF/AFL prevalence, incidence, DALY, and YLD rates in young people worldwide during 1990–2019. In the last three decades, the AF/AFL prevalence, mortality, DALY, and YLD rates have increased in people in every age group globally. Similarly, an identical trend was observed among people aged 25–49 years. Figure 2 illustrates that the incidence and YLD rates among young people increased between 1990 and 2019, whereas the prevalence, incidence, DALY, and YLD rates have shown a decline in the last six years. These trends are likely linked to advancements in early diagnosis and specialized treatment in recent years. However, some remote areas may still experience missed or incorrect diagnoses due to insufficient medical equipment. Furthermore, young individuals tend to adhere more effectively to lifestyle modifications and medical treatments, which enhances disease prevention and management [32]. Yet, with the ongoing spread of COVID-19, an incremental rise in the incidence rate of AF/AFL is anticipated, presenting a significant challenge to both public health and societal development [33, 34]. It is advisable for governments across various countries and regions to implement effective strategies to mitigate the global burden of AF/AFL.
Quantifying the burden of AF/AFL related to the SDI in young people could facilitate understanding of the distribution patterns of disease burden in relation to the level of socioeconomic development. Findings from a Mendelian randomization study suggest that individuals with higher education levels may have a reduced likelihood of engaging in smoking, consuming high salt diets, and being exposed to depression or air pollution. In addition, these people might have more household income and perform more physical activities. In summary, a high education level likely reduces CVD incidence via cardiovascular biomarkers and socioeconomic factors. It is highly important to reduce education inequality during the management of cardiovascular diseases[35]. The risk factors for AF differ depending on country-income level. AF may greatly increase the stroke burden among high-income countries compared with low-income countries because of the high prevalence of AF, regardless of the magnitude of the odds ratio [36]. In this work, the same conclusions were drawn for young AF/AFL patients. Inequality analysis of young AF/AFL people among different countries was carried out by the WHO standard health equity analysis method. According to our results, countries with larger SDI exhibited disproportionately greater AF/AFL burdens. Additionally, the SDI-related inequality degree of the AF/AFL burden in young people increases with time. This indicates insufficient investments in AF/AFL prevention and treatment in the last three decades with the improvement of socioeconomic development. Considering the elevated disease burden, healthcare decision-makers should attach more importance to AF/AFL in young people, particularly in high-/middle-SDI countries, and reinforce primary healthcare and prevention of AF/AFL. Measures such as smoking cessation, salt consumption reduction, fasting glucose control, early hypertension management, maintaining a healthy and regular lifestyle, and healthy eating habits in children may help decrease AF/AFL-induced premature illness or even deaths in young people [37–39].
To the authors' knowledge, this study represents the most extensive and up-to-date analysis of the global burden of AF/AFL in the 25- to 49-year-old demographic over the last three decades (1990–2019). This work offers significant strengths, including a long-term observational period, a wide geographical scope, and a large dataset. However, it is important to acknowledge certain limitations. Firstly, the representation of patients from low-income countries in the GBD study may be underestimated due to constraints in disease diagnosis and reporting capabilities, as well as suboptimal healthcare infrastructure. Such limitations could lead to misdiagnosis, underdiagnosis, and loss of medical records. Secondly, this study heavily relies on secondary data, and the results derived from GBD modeling might not accurately reflect real-world data. Additionally, genetic factors and ethnicity are known to influence the distribution of AF/AFL across different countries and regions [40, 41]. However, there is a dearth of GBD studies focusing on various ethnic groups; thus, future research should concentrate on gathering and analyzing data related to ethnicity.