Rising Mortality from Atrial Fibrillation and COPD Comorbidity in the United States, 1999–2024: Implications for Cardiopulmonary Care in South Asia

Background Atrial fibrillation and chronic obstructive pulmonary disease COPD frequently coexist, yet national mortality patterns of this high-risk dyad are not clearly understood. We assessed long-range patterns and inequities of atrial fibrillation-related mortality among adults with COPD in the United States. Methods Using CDC WONDER Multiple Cause of Death files (1999–2024), we identified decedents of ≥ 25 years with atrial fibrillation (ICD-10 I48) and COPD (J41–J44) as contributing or underlying causes. We calculated age-adjusted mortality rates (AAMR) per 100,000 (2000 U.S. standard) and estimated Annual Percent Change (APC) and Average APC (AAPC) using Joinpoint Regression, stratifying on sex, race/ethnicity, census region/state, urbanicity, and place of death. Results There were 577,367 atrial fibrillation-COPD deaths. National AAMR increased from 5.56 (1999) to 13.96 (2024) (AAPC + 3.73%, 95% CI + 3.53 to + 3.91; p < 0.000001), with a rise through 2018 (APC + 4.08%) and a surge to 2021 (APC + 6.76%), followed by a nonsignificant decline thereafter (APC − 1.36%). Men had higher AAMR than women (overall 12.27 vs 7.64), but women’s rates rose faster (AAPC + 4.01% vs + 3.11%). AAMR was highest in White individuals (10.92), while the steepest increase occurred in Black individuals (AAPC + 5.11%). The Midwest had the highest regional AAMR (10.23) and the Northeast the lowest (8.31). Non-metropolitan areas exceeded metropolitan areas (10.68 vs 8.27; AAPC + 5.24% vs + 4.10%). Most deaths occurred in medical facilities (40.17%), followed by home (27.97%) and nursing homes/long-term care (22.64%). Conclusion Mortality from atrial fibrillation-COPD increased dramatically over 25 years, with more rapid expansion for women, non-Hispanic blacks, and people from non-metropolitan areas. These results argue for prevention aimed at selected subgroups, combined cardiopulmonary care, broader rural access, and earlier palliative care to narrow inequities and optimize outcome.