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Global trends and regional disparities in atrial fibrillation and flutter burden attributable to high alcohol consumption: findings from the global burden of disease study 2021

BMC Cardiovascular Disorders volume 25, Article number: 266 (2025) Cite this article

Abstract

Objectives

To evaluate the global burden of atrial fibrillation (AF) and atrial flutter (AFL) attributable to high alcohol consumption (HAC) from 1990 to 2021, and to examine its spatiotemporal distribution characteristics.

Study design

An observational study based on Global Burden of Disease Study (GBD) 2021 data.

Methods

Using GBD 2021 data, we analyzed trends in disability-adjusted life years (DALYs) and mortality for AF/AFL attributable to HAC at the global, regional, and national levels from 1990 to 2021, with a focus on differences by gender, age, and socio-demographic index (SDI).

Results

DALYs for HAC-attributable AF/AFL rose from 155,703 (95% UI: 105,255–206,083) in 1990 to 362,698 (95% UI: 263,321–465,594) in 2021, while mortality increased from 4,308 (95% UI: 3,000–5,597) to 11,908 (95% UI: 7,826–30,753). Males and individuals aged ≥ 60 years experienced the highest burdens. Australasia recorded the highest DALYs and mortality in 2021, while South Asia showed the steepest increases, with EAPCs of 2.95 and 4.18, respectively. Higher SDI regions showed greater burdens, peaking at an SDI of 0.8 before declining.

Conclusions

HAC contributes significantly to the global AF/AFL burden, with marked regional and demographic disparities. Targeted interventions are urgently needed to address this growing public health challenge.

Peer Review reports

Introduction

Atrial fibrillation (AF) and atrial flutter (AFL) are common supraventricular arrhythmias characterized by rapid and irregular atrial activation, leading to ineffective atrial contraction [1]. These conditions significantly diminish quality of life and are strongly associated with an increased risk of stroke, heart failure, and all-cause mortality, imposing a substantial economic burden on global healthcare systems [2,3,4]. Over the past few decades, the global prevalence of AF/AFL has risen sharply. According to the Global Burden of Disease Study (GBD) 2019, the absolute number of individuals with AF/AFL has more than doubled, accompanied by a marked increase in AF/AFL-related mortality and disability-adjusted life years (DALYs), making it one of the leading causes of global disability [5]. In the Asia-Pacific region alone, more than 16 million individuals are currently diagnosed with AF, a number projected to reach 72 million by 2050 [6]. Furthermore, recent trends indicate a substantial rise in AF/AFL -related hospitalizations, further intensifying the burden on patients and healthcare systems worldwide [7, 8]. Despite advancements in pharmacological therapies and cardioversion techniques, the persistently high incidence, recurrence rates, and associated healthcare challenges underscore the urgent need for a deeper understanding of AF/AFL pathophysiology and the development of more effective management strategies [9].

The etiology of AF and AFL is multifaceted, driven by a combination of risk factors, including hypertension, smoking, alcohol consumption, high sodium intake, obesity, and sociodemographic variables [10]. Among these, alcohol consumption has been identified as a significant contributor to AF/AFL development, particularly in high-risk populations [11,12,13]. Both alcohol and its primary metabolite, acetaldehyde, play pivotal roles in the pathogenesis of AF/AFL through several interconnected mechanisms. Alcohol exposure disrupts cardiomyocyte function by impairing calcium regulation, reducing left ventricular contractility, and inducing diastolic dysfunction. Moreover, alcohol adversely affects cardiac electrophysiology by diminishing L-type calcium channel currents, shortening action potential duration, and reducing atrial effective refractory periods. These disruptions contribute to electrical and structural remodeling, increasing susceptibility to AF/AFL. Additionally, alcohol-induced oxidative stress and autonomic nervous system dysregulation further exacerbate arrhythmogenic remodeling, fostering a pro-arrhythmic environment [14]. Extensive evidence from meta-analyses has established a strong association between heavy alcohol consumption and an elevated risk of AF/AFL [15, 16]. Notably, individuals consuming 35 or more drinks per week face a substantially higher likelihood of developing AF/AFL, with approximately 5% of AF/AFL cases in men attributable to excessive alcohol intake [17]. Given these findings, a comprehensive assessment of the global disease burden of AF/AFL related to HAC is crucial for informing effective prevention and management strategies. However, such studies remain limited, underscoring a critical gap in the current research.

The GBD is a comprehensive initiative aimed at quantifying the health impact of diseases, injuries, and risk factors across diverse populations and regions. By employing standardized methodologies and integrating extensive epidemiological data, the GBD study provides robust estimates of key health metrics, such as DALYs and mortality rates [18]. In recent years, GBD-based analyses have significantly enhanced the epidemiological understanding of AF and AFL. Studies utilizing GBD 2019–2021 data have delineated the global distribution of AF/AFL burden and identified key modifiable risk factors [5, 19]. Notably, high systolic blood pressure (HSBP), high body mass index (BMI), and HAC were recognized as the leading contributors to AF/AFL-related mortality in 2019 [5]. Jin et al. [20] estimated the AF/AFL burden attributable to HSBP, highlighting its disproportionate impact on women, older adults, and populations in low-resource settings. Similarly, Kong et al. [21] analyzed GBD 2021 data to assess the AF/AFL burden associated with high BMI, offering critical insights for region-specific health interventions aimed at mitigating high BMI-related AF/AFL risk. These findings underscore the necessity of assessing key risk factors across demographic and geographical strata to inform targeted preventive strategies.

However, the contribution of HAC to AF/AFL burden remains insufficiently quantified. While alcohol is widely recognized as a significant risk factor, its specific impact on DALYs and mortality has not been systematically assessed using the latest GBD data. This study seeks to address this gap by leveraging GBD 2021 data to evaluate the HAC-attributable burden of AF/AFL, with a focus on DALYs and mortality. Unlike previous studies centered on HSBP and BMI, this research examines HAC as a major contributor, providing novel insights for global prevention strategies and public health policy development.

Methods

Data sources and collection

The GBD 2021 conducted a comprehensive assessment of 371 diseases and injuries and 88 risk factors across 204 countries and territories, utilizing updated epidemiological data and enhanced standardized methodologies. The cause-of-death database integrates seven types of data sources: vital registration, verbal autopsy, cancer registries, police records, sibling history, surveillance, surveys/censuses, and minimally invasive tissue sampling diagnostics. To enhance the comparability of mortality data, statistical methods are applied, including reclassification of nonspecific or unspecified codes, noise reduction algorithms, and the Cause of Death Ensemble model (CODem) [18]. DALYs are calculated as the sum of years lived with disability and years of life lost. A detailed description of the GBD’s design, including risk factor attribution methodologies, is available in existing literature [22, 23].

This study focuses on the AF/AFL burden attributable to HAC across 204 countries and territories. The primary data source was the Global Health Data Exchange (GHDx) (https://ghdx.healthdata.org/), provided by the Institute for Health Metrics and Evaluation (IHME) [23]. The study variables included DALYs and mortality, with results reported as absolute counts, crude rates, and age-standardized rates (ASRs) per 100,000 population. Subgroup analyses were stratified by sex, age (25 to 95 + years), and the Socio-demographic Index (SDI). As this study utilized de-identified, publicly available epidemiological datasets, it was exempt from ethical review requirements.

Definition of AF/AFL and high alcohol use

AF/AFL, common supraventricular arrhythmias characterized by rapid and irregular atrial activation, were identified based on the International Classification of Diseases (ICD-9 codes 427.3–427.32 and ICD-10 codes I48–I48.92) [20]. HAC was evaluated as the daily consumption of pure ethanol in grams, with a standard drink defined as 10 g of ethanol [24].

Statistical analysis

To evaluate temporal trends, we calculated the EAPC of ASRs. Assuming a linear relationship between the natural logarithm of ASR and time, we applied the model: Y = α + βX + ε, where Y represents ln(ASR), X denotes calendar year, ε is the error term, and β is the regression coefficient. EAPC was computed using the formula EAPCwith 95%CI=100×(exp(β) − 1). A positive EAPC with a lower bound of the 95% confidence interval (CI) above zero indicates an increasing ASR trend, whereas a negative EAPC with an upper bound of the CI below zero signifies a decreasing ASR trend. Additionally, Spearman’s correlation coefficient was used to examine the relationship between SDI and ASRs. A smoothing spline model was further employed to analyze the staged trends in this correlation. All statistical analyses were performed using R software (version 4.3.1). A p-value of < 0.05 was considered statistically significant.

Results

Global trends in HAC-attributable AF/AFL burden

Globally, the absolute number of DALYs for HAC-attributable AF/AFL increased from 155,703 (95% UI: 105,255–206,083) in 1990 to 362,698 (95% UI: 263,321–465,594) in 2021. Over the same period, the age-standardized mortality rate (ASMR) exhibited a slight decline, from 4.4 (95% UI: 2.95–5.79) per 100,000 in 1990 to 4.32 (95% UI: 3.15–5.57) per 100,000 in 2021, with an EAPC of 0.03 (95% CI: 0.00–0.07). In contrast, HAC-attributable AF/AFL mortality increased substantially, with the absolute number of mortality rising from 4,308 (95% UI: 3,000–5,597) in 1990 to 11,908 (95% UI: 7,826–30,753) in 2021, corresponding to an EAPC of 0.15 (95% CI: 0.11–0.15) (Table 1). Throughout this period, males exhibited a higher burden of HAC-attributable AF/AFL DALYs and mortality than females (Fig. 1).

Table 1 The dalys, mortality, and their estimated annual percentage changes of atrial fibrillation and flutter attribute to high alcohol consumption from 1990 to 2021
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Fig. 1
figure 1

Global burden of atrial fibrillation and atrial flutter attributable to high alcohol consumption from 1990 to 2021. (A) Numbers and ASRs (per 100,000) of DALYs. (B) Numbers and ASRs of mortality. Error bars and shaded regions indicate 95% uncertainty intervals. DALYs: disability-adjusted life years; ASR: age-standardized rate

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Sex- and age-specific burdens

DALYs for AF/AFL attributable to HAC increased significantly among individuals aged 60 years and older (Fig. 2A). Mortality from HAC-related AF/AFL rose sharply in those aged 70 and above, with the highest rates observed in individuals over 80 years old (Fig. 2B). Both DALYs and mortality rates exhibited a clear age-related increase in both sexes, with a pronounced surge after age 75 (Fig. 2C and D). Males consistently demonstrated higher DALYs and mortality rates than females, with the greatest disparities observed in the 80-and-older age group. Gender- and age-specific data are provided in Table S1.

Fig. 2
figure 2

Age-specific burden of atrial fibrillation and atrial flutter attributable to high alcohol consumption for males and females in 2021. DALYs rates for males and females across different age groups in 2021(A and C). mortality rates for males and females across different age groups in 2021(B and D). DALYs: disability-adjusted life years

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Among the five SDI categories, the High SDI region exhibited the highest age-standardized DALYs (8.2; 95% UI: 5.97–10.62) and ASMR (0.26; 95% UI: 0.2–0.33). The corresponding EAPCs were 0.25 (95% CI: 0.19–0.32) and 0.38 (95% CI: 0.32–0.45), indicating an increasing burden. Conversely, the High-Middle SDI region demonstrated a declining burden. DALYs decreased from 4.83 (95% UI: 3.19–6.45) in 1990 to 4.35 (95% UI: 3.11–5.69) in 2021, with an EAPC of -0.31 (95% CI: -0.38 to -0.25). Similarly, ASMR in this region declined, with an EAPC of -0.1 (95% CI: -0.16 to -0.03) (Table 1; Fig. 3).

Fig. 3
figure 3

Estimated annual percentage changes in age-standardized rates of DALYs and mortality for atrial fibrillation and atrial flutter attributable to high alcohol consumption across 21 regions from 1990 to 2021

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Regional and National variations

Regional burden and trends of AF/AFL attributable to HAC are summarized in Table 1; Fig. 3. While most regions exhibited an increasing trend in DALYs and mortality for HAC-related AF/AFL, the High-Income Asia Pacific and Central Latin America regions demonstrated a declining burden (Fig. 3).

Among all regions, Australasia reported the highest burden in 2021, with an age-standardized DALYs rate of 0.42 (95% UI: 0.22–0.62) and an ASMR of 0.43 (95% UI: 0.3–0.57). Conversely, the North Africa and Middle East regions recorded the lowest burden, with an age-standardized DALYs rate of 0.22 (95% UI: 0.14–0.3) and an ASMR of 0.01 (95% UI: 0–0.01) (Table 1). Notably, South Asia experienced the steepest increases, with EAPCs for DALYs and mortality reaching 2.95 (95% CI: 2.62–3.27) and 4.18 (95% CI: 3.72–4.65), respectively (Table 1).

At the national level, similar patterns of regional disparities were observed, further emphasizing geographical variations (Fig. 4, Table S2). Iceland reported the highest age-standardized DALYs rate in 2021, increasing from 4.37 (95% CI: 2.44–6.52) in 1990 to 9.7 (95% CI: 6.85–12.87). The corresponding ASMR rose from 0.15 (95% CI: 0.07–0.23) in 1990 to 0.36 (95% CI: 0.25–0.49) in 2021, marking a more than two-fold increase (Fig. 4A and C, Table S2). Myanmar exhibited the most pronounced increase among 204 countries, with EAPCs for DALYs and mortality at 9.71 (95% UI: 9.17–10.26) and 10.99 (95% UI: 10.43–11.56), respectively (Fig. 4B and D). In contrast, several countries—including Djibouti, Bhutan, and Bahrain—demonstrated notable reductions in HAC-attributable AF/AFL burden, with consistent declines in age-standardized DALYs rate and ASMR over time (Fig. 4B and D, Table S2).

Fig. 4
figure 4

National age-standardized rates of DALYs and mortality for atrial fibrillation and atrial flutter attributable to high alcohol consumption and their estimated annual percentage changes from 1990 to 2021. (A) National age-standardized DALYs rates and their estimated annual percentage changes. (B) National age-standardized mortality rates and their estimated annual percentage changes. DALYs: disability-adjusted life years; ASR: age-standardized rate; EAPC: estimated annual percentage change

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Spearman correlation and smooth curve analysis

Spearman correlation analysis revealed a significant association between age-standardized DALYs rates for HAC-attributable AF/AFL and the SDI across 21 global regions (R = 0.712, P < 0.001). Similarly, a significant correlation was observed between ASMR for HAC-related AF/AFL and SDI (R = 0.580, P = 0.005). Further analysis using a smooth curve model indicated a non-linear relationship between ASRs and SDI on a global scale. Age-standardized DALYs rates and ASMR increased with rising SDI values, peaking when the SDI reached approximately 0.8. Beyond this threshold, ASRs declined significantly in high-SDI regions such as Andean Latin America, Western Europe, and Australasia (Fig. 5A and B). Among the 204 countries and regions analyzed, age-standardized DALYs rates and ASMR generally increased with rising SDI, with a more pronounced upward trend in regions where SDI values exceeded 0.7 (Fig. 5C and D).

Fig. 5
figure 5

SDI-based age-standardized rates of DALYs and mortality for atrial fibrillation and atrial flutter attributable to high alcohol consumption. (A) SDI-based age-standardized DALYs rates in 21 regions from1990 to 2021. (B) SDI-based age-standardized mortality rates in 21 regions from1990 to 2021. (C) SDI-based age-standardized DALYs rates across countries in 2021. (D) SDI-based age-standardized mortality rates across countries in 2021. SDI: Socio-demographic Index; DALYs: disability-adjusted life years; ASR: age-standardized rate

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Discussion

This study presents the first comprehensive global assessment of the burden of AF/AFL attributable to HAC, utilizing GBD 2021 data. Our findings demonstrate a substantial increase in HAC-related AF/AFL burden from 1990 to 2021, as evidenced by rising DALYs and mortality rates. Notably, the burden is unevenly distributed, disproportionately affecting males, older adults, and populations in high-SDI regions. These results underscore the growing public health challenge posed by alcohol consumption in AF/AFL epidemiology and highlight the urgent need for targeted interventions to mitigate its impact.

Burden of AF/AFL attributable to HAC in older adults

HAC plays a critical role in exacerbating the disease burden of AF/AFL in older adults, compounding cardiovascular risks and worsening patient outcomes [11, 25, 26]. In elderly individuals with AF/AFL, excessive alcohol intake contributes to atrial structural and electrical remodeling, oxidative stress, and autonomic dysfunction, thereby increasing the risk of comorbidities such as heart failure and stroke [14]. Moreover, heavy alcohol consumption is associated with a poorer prognosis, as it elevates the risk of AF/AFL recurrence and related complications, particularly among high-risk populations [26, 27]. Previous studies have identified gender disparities in AF/AFL burden, with females experiencing a greater overall DALY and mortality burden in 2021 [20, 28]. Importantly, gender-based differences in the impact of various risk factors on AF/AFL have also been observed [29, 30]. However, our analysis reveals that excessive alcohol intake has a more pronounced impact on elderly males, aligning with previous findings that heavy alcohol consumption in men is associated with a higher risk of AF-related adverse events, including thromboembolic complications [26]. Additionally, male sex is itself a recognized risk factor for AF development [31, 32]. This disparity may be attributed to physiological differences in alcohol metabolism, as well as higher smoking prevalence and an increased burden of cardiovascular comorbidities among males with high alcohol intake [33]. These findings highlight the urgent need for tailored public health strategies to reduce alcohol consumption among older males, a high-risk group for alcohol-induced AF/AFL complications.

Regional variations in the burden of HAC-attributable AF/AFL

Our analysis reveals substantial regional disparities in the burden of AF/AFL attributable to HAC, reflecting variations in drinking patterns, socio-economic development, and healthcare infrastructure. In 2021, Australasia reported the highest HAC-attributable AF/AFL burden, with age-standardized DALYs rate and ASMR significantly exceeding those of other regions. This finding is consistent with prior studies linking high levels of alcohol consumption in Australasia to cultural norms and the widespread availability of alcohol [34, 35]. These results highlight the urgent need for targeted public health interventions in the region, including (1) Stronger alcohol taxation policies and restrictions on alcohol advertising, which have been shown to reduce excessive alcohol consumption and improve cardiovascular outcomes [36]. (2) Screening programs for AF/AFL in heavy alcohol users, integrated into routine primary care visits to facilitate early detection and management. (3) Public awareness campaigns emphasizing the link between alcohol consumption and AF/AFL, utilizing digital media and community-based education initiatives to enhance outreach and engagement [37].

South Asia exhibited the most pronounced increase in HAC-attributable AF/AFL burden, with EAPCs of 2.95 for DALYs and 4.18 for mortality. This trend likely reflects the rising prevalence of alcohol consumption, driven by socio-economic development and urbanization. Additionally, limited healthcare infrastructure for early diagnosis and management of AF/AFL further exacerbates the disease burden in this region. Addressing these challenges will require: (1) Culturally sensitive education campaigns that emphasize the risks of HAC-related AF/AFL, particularly targeting younger populations [38, 39]. (2) Integration of AF/AFL screening into existing hypertension and cardiovascular disease programs to facilitate earlier detection and intervention [40]. (3) Stronger alcohol regulation policies, including restrictions on alcohol availability and sales hours, to curb high-risk drinking behaviors and mitigate their associated health consequences [41].

Consistent with previous studies [19, 28], our findings reveal a near-linear positive correlation between SDI and the burden of AF/AFL attributable to HAC. The variation in AF/AFL burden across countries likely reflects differences in underlying etiological factors, diagnostic capabilities, ethnic composition, healthcare resources, and treatment availability. In high-SDI regions, advanced healthcare systems and greater public awareness may facilitate improved AF/AFL diagnosis and reporting. In contrast, regions with limited healthcare infrastructure face challenges in data collection and disease surveillance, potentially leading to an underestimation of the true AF/AFL burden. These findings underscore the urgent need to strengthen surveillance and reporting systems in resource-limited settings to ensure more accurate disease burden estimates. Moreover, our results highlight the effectiveness of public health measures in mitigating the impact of alcohol consumption on AF/AFL and provide valuable insights for other regions experiencing rising burdens [5, 42].

Confounding factors in HAC-related AF/AFL burden

While our study provides robust epidemiological estimates of the HAC-attributable AF/AFL burden, several confounding factors must be considered when interpreting these findings. A key confounder is genetic predisposition, which varies widely across populations and may influence individual susceptibility to AF/AFL, independent of alcohol consumption. Genetic factors can affect cardiac structure and function, potentially modifying the risk associated with alcohol intake [43]. Additionally, excessive alcohol consumption often coexists with other unhealthy behaviors, including smoking, poor diet, and physical inactivity, all of which independently contribute to AF/AFL development. Among these, smoking is particularly concerning, as it exacerbates oxidative stress and endothelial dysfunction, further increasing AF/AFL susceptibility in heavy drinkers. Moreover, sedentary lifestyles and obesity—both of which are more prevalent in populations with high alcohol intake—may serve as mediators in the alcohol- AF/AFL relationship [44]. These factors complicate the causal interpretation of alcohol’s role in AF/AFL burden, underscoring the need for further investigations incorporating individual-level risk adjustments to better delineate these complex interactions.

Limitations and clinical significance

While our study provides critical insights into the global burden of HAC-related AF/AFL, several limitations must be acknowledged. First, the absence of complementary wet-lab data, such as cell-based or animal model experiments, limits our ability to elucidate the underlying biological mechanisms linking alcohol consumption to AF/AFL. Incorporating such data in future studies could enhance our mechanistic understanding of these associations and inform the development of targeted interventions. Second, while the GBD methodology employs standardized adjustments to minimize potential biases arising from changes in disease classification, diagnostic practices, and case ascertainment, we recognize that these modifications—along with reduced societal stigma surrounding alcohol use disorders (AUDs)—may have contributed to the increased visibility of HAC-attributable AF/AFL in registry data. Future research integrating individual-level clinical data and longitudinal cohort analyses is warranted to further validate these findings and refine risk attribution models in the context of evolving healthcare practices and social perceptions. Additionally, the GBD framework does not account for individual-level risk factors, such as lifestyle behaviors, comorbidities, or genetic predisposition, which may mediate the observed association between alcohol consumption and AF/AFL. Finally, alcohol exposure in the GBD framework is defined solely in terms of high consumption, without distinguishing between drinking patterns (e.g., binge drinking versus moderate regular intake). This limitation may affect the interpretation of regional variations in HAC-related AF/AFL burden, given the distinct physiological and cardiovascular risks associated with different drinking behaviors. Future studies should incorporate more granular data on alcohol consumption patterns to refine risk estimates and better inform region-specific public health strategies.

Despite these limitations, this study provides valuable epidemiological evidence highlighting the rising burden of alcohol-induced AF/AFL, particularly among older adults and high-SDI regions. These findings underscore the urgent need for targeted public health interventions, including alcohol reduction initiatives, enhanced AF/AFL screening programs, and improved disease management strategies to mitigate the growing impact of HAC-related AF/AFL.

Conclusions

In summary, this study highlights a substantial increase in the health burden of AF/AFL attributable to HAC over recent decades, particularly among elderly populations and high-SDI regions. These findings underscore the critical need for targeted public health interventions aimed at reducing alcohol consumption and improving health outcomes in vulnerable populations. Future research should focus on addressing region- and population-specific needs to facilitate the development and implementation of effective health intervention strategies tailored to diverse epidemiological and socio-economic contexts.

Data availability

Data used for the analyses are publicly available from the Institute of Health Metrics and Evaluation (http://www.healthdata.org/; http://ghdx.healthdata.org/gbd-results-tool).

Abbreviations

AF:

Atrial Fibrillation

AFL:

Atrial Flutter

GBD:

Global Burden of Disease

DALYs:

Disability-Adjusted Life Years

HSBP:

High Systolic Blood Pressure

BMI:

Body Mass Index

EAPC:

Estimated Annual Percentage Change

SDI:

Sociodemographic Index

ASMR:

Age-Standardized Mortality Rate

ASR:

Age-Standardized Rate

GHDx:

Global Health Data Exchange

IHME:

Health Metrics and Evaluation

UI:

Uncertain Interval

CI:

Confidence Interval

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Acknowledgements

We truly appreciate the efforts of the Global Burden of Disease Study 2021 collaborators in delivering the most complete study of various diseases on a worldwide scale. We also express our sincere appreciation to the Institute for Health Metrics and Evaluation (IHME) for making the GBD data available for this research.

Funding

None. This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

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Authors and Affiliations

  1. Department of Electrocardiogram, Weifang People’s Hospital, No. 151, Guangwen Street, Kuiwen District, Weifang City, 261000, Shandong Province, China

    Yunkai Hua & Wenjun Han

  2. Department of Cardiology, Weifang People’s Hospital, Weifang, 261000, Shandong, China

    Jinpeng Liu

  3. Department of Cardiovascular Disease, Weifang Hospital of Traditional Chinese Medicine, Weifang, 262600, Shandong, China

    Kui Ji

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  1. Yunkai Hua
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Contributions

Methodology, Y.H., J.L. and W.H.; Software, Y.H.; Formal analysis, Y.H. and J.L.; Writing—original draft, Y.H. J.L. and K.J.; Writing—review & editing, W.H.; Visualization, Y.H., J.L. and K.J.; Supervision, W.H.; Project administration, W.H. All authors have read and agreed to the published version of the manuscript.

Corresponding author

Correspondence to Wenjun Han.

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Ethics approval and consent to participate

The GBD study’s protocol has been approved by the research ethics board at the University of Washington (UW). The GBD studies must be conducted in full compliance with UW policies and procedures, as well as applicable federal, state, and local laws. Therefore, all ethical standards are justified by properly citing the respective sources (http://ghdx.healthdata.org/gbd-results-tool). Consequently, ethical approval and consent procedure are not required for this study.

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Not applicable.

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The authors declare no competing interests.

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Hua, Y., Liu, J., Ji, K. et al. Global trends and regional disparities in atrial fibrillation and flutter burden attributable to high alcohol consumption: findings from the global burden of disease study 2021. BMC Cardiovasc Disord 25, 266 (2025). https://doiorg.publicaciones.saludcastillayleon.es/10.1186/s12872-025-04699-4

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Keywords

BMC Cardiovascular Disorders

ISSN: 1471-2261

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