Background: Atrial Fibrillation (AF) is characterized by irregular and often rapid heartbeats due to disorganized electrical activity in the atria. AF has been posing serious threats to the population by exacerbating cardiovascular risks, such as stroke and thrombophlebitis. Thrombophlebitis is a condition that causes a blood clot to form and block one or more veins, affecting many adults in the U.S annually, and warranting immediate need for interventions. AF patients, who are already at an increased risk of thromboembolic events, when affected by phlebitis/thrombophlebitis, can die due to serious complications such as pulmonary embolism.

Methods: Death certificates from the Centers for Disease Control and Prevention's Wide-Ranging Online Data for Epidemiologic Research database were examined from 1999 to 2023 for multiple causes of death, using ICD-10 Codes. Adults aged 45 years and older were evaluated for. Annual Percent Change (APC) and Average Annual Percent Change (AAPC) were calculated to identify trends in mortality rates. Joinpoint regression analysis was used to identify points in time where the mortality trend significantly changed. Our data was stratified by gender, race, age groups, urbanization, and geographical regions for detailed analysis. Statistical significance was set at an alpha level of 0.05.

Results: Between 1999 and 2023, 35,059 deaths were recorded. The overall AAPC was 5.15* (95% CI: 3.54-6.78, p value=0.000001). AAMR increased from 0.45 in 1999 to 1.63 in 2023. The most significant change was noted between 1999 and 2001 (APC: 21.67*,95% CI: 4.70-41.38), followed by 2018 to 2021 (APC: 14.18* 95%CI: 6.35-22.58). Females (AAMR 1.03) and males (AAMR 1.20) both exhibited overall increases, with Males exhibiting a more significant change (AAPC: 4.88* 95% CI: 2.84-6.96). Regional differences were evident, with the West showing the highest AAMR (1.09), followed by the Midwest (1.08), the south (1.04), and the Northeast (1.02). There were evident disparities among the races, with Whites showing the highest AAMR (1.07), most significantAPC noticed from 1999-2002 (APC: 19.95* 95% CI: 1.97-41.1), followed by African Americans (1.04), Hispanics (0.6), American Indians (0.49), and Asians or Pacific Islanders (0.35), with an overall significant change in Whites (AAPC: 4.98* 95% CI: 3.00-7.01) and African Americans (AAPC: 5.14* 95%CI: 4.28-6.00). Metropolitan status influenced mortality trends, with Micropolitan areas having highest AAMR (1.09), followed by Medium Metro (1.08), Small Metro (1.08), non-core nonmetro (1.06), Large Central (1.05), and Large Fringe (1.04). State level AAMRs ranged from 1.69 (Colorado and West Virginia) to 0.47 (Hawaii).

Conclusion: Mortality from phlebitis/thrombophlebitis and atrial fibrillation/flutter in U.S. adults aged ≥45 years showed fluctuating trends between 1999 and 2023, with an overall increase in mortality rates. The disparities noticed across different demographic segments, such as White men, urban citizens and the Southern region highlight the need for further investigation into the factors driving these trends and disparities. Targeted interventions are needed for the high-risk population to mitigate these inequities.

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2025
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