P3068 - Trends and Disparities in Mortality Among Older Adults With Atrial Fibrillation and Gastrointestinal Bleeding in the United States, 1999–2020

Anmol Mohan, MD¹, Priyanka Mohan Lal, MBBS², Abdullah Sultany, MD³
1Carle Foundation hospital, Urbana, IL; 2Ziauddin University, Karachi, Sindh, Pakistan; 3Guthrie Robert Packer Hospital, Department of Internal Medicine, Sayre, PA

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 females (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).

Discussion: 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.


Figure: Figure 1. Age Adjusted Mortality Rates for Atrial Fibrillation and Gastrointestinal Bleeding per 100,000, Stratified by (A)
Gender and Overall, (B) Race, (C) Urbanization and (D) Census Region in the United States from 1999 to 2020.


Figure: Figure 2. Atrial Fibrillation and Gastrointestinal Related Age Adjusted Mortality Rates Stratified by
State in the United States from 1999 to 2020.

Disclosures:
Anmol Mohan indicated no relevant financial relationships.
Priyanka Mohan Lal indicated no relevant financial relationships.
Abdullah Sultany indicated no relevant financial relationships.

Anmol Mohan, MD¹, Priyanka Mohan Lal, MBBS², Abdullah Sultany, MD³. P3068 - Trends and Disparities in Mortality Among Older Adults With Atrial Fibrillation and Gastrointestinal Bleeding in the United States, 1999–2020, ACG 2025 Annual Scientific Meeting Abstracts. Phoenix, AZ: American College of Gastroenterology.