Abstract
INTRODUCTION: Tobacco use is a key modifiable risk factor for atrial fibrillation/flutter (AF/AFL). We assessed global, regional, and national burdens attributable to smoking from 1990 to 2021 and projected future trends. METHODS: Data on deaths and DALYs were extracted from the GBD 2021 study. Main statistical analyses included the calculation of ASMR and ASDR. Trends were quantified using the estimated annual percentage change (EAPC). An age-period-cohort (APC) model was employed to decompose the effects of age, period, and birth cohort. Furthermore, a Bayesian age-period-cohort (BAPC) model was utilized to project the disease burden through 2045. RESULTS: In 2021, AF/AFL related to tobacco caused around 396000 cases, more than 10000 deaths, and 400000 disability-adjusted life years (DALYs). Compared with 1990, absolute cases and DALYs increased, while ASDR and ASR DALY declined (20%). High SDI regions improved most; low SDI regions lagged. Men and older adults bore disproportionate burdens. By 2045, deaths are projected to reach 14500 and 4200, respectively. Despite rising absolute DALYs, ASMR and ASDR are expected to decline in both sexes. CONCLUSIONS: Although standardized rates declined, the absolute burden of tobacco-related AF/AFL continues to rise, highlighting the urgent need for stronger tobacco control and targeted interventions in vulnerable populations.