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Arrhythmias and sudden death
Original research
Birth cohort effects on diagnosed atrial fibrillation incidence: nationwide cohort study from 1980 to 2018
  1. Nicklas Vinter1,2,3,
  2. Pia Cordsen1,
  3. Søren Paaske Johnsen1,
  4. Emelia J Benjamin4,5,
  5. Lars Frost2,3,
  6. Ludovic Trinquart1,6,7,8
  1. 1 Danish Center for Health Services Research, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
  2. 2 Diagnostic Centre, University Clinic for Development of Innovative Patient Pathways, Silkeborg Regional Hospital, Silkeborg, Denmark
  3. 3 Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
  4. 4 Department of Medicine, Boston Medical Center, Boston University Chobanian and Avedisian School of Medicine, Boston, Massachusetts, USA
  5. 5 Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts, USA
  6. 6 Tufts Clinical and Translational Science Institute, Tufts University, Boston, Massachusetts, USA
  7. 7 Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, Massachusetts, USA
  8. 8 Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts, USA
  1. Correspondence to Dr Nicklas Vinter, Department of Clinical Medicine, Aalborg University, Aalborg, 9260, Denmark; nicvin{at}rm.dk

Abstract

Background The incidence of atrial fibrillation (AF) shows substantial temporal trends, but the contribution of birth cohort effects is unknown. These effects refer to the relationship between birth year and the likelihood of developing AF. We aimed to assess trends in cumulative incidence of diagnosed AF across birth cohorts and to disentangle the effects of age, birth cohort and calendar period by using age–period–cohort analyses.

Methods In a Danish nationwide population-based cohort study, 4.7 million individuals were selected at a given index age (45, 55, 65 and 75 years) free of AF and followed up for diagnosed AF. For each index age, we assessed trends in 10-year cumulative incidence of AF across six 5-year birth cohorts. An age–period–cohort model was estimated using Poisson regression with constrained spline functions collapsing data into 1-year intervals across ages and calendar years.

Results Cumulative incidence of AF diagnosis increased across birth cohorts for all index ages (ptrend<0.001). Compared with the first birth cohort, the diagnosed AF incidence rate ratio in the last birth cohort was 3.0 (95% CI 2.9 to 3.2) for index age 45 years, 2.9 (2.8 to 3.0) for 55 years, 2.8 (2.7 to 2.8) for 65 years and 2.7 (2.6 to 2.7) for 75 years. Age–period–cohort analyses showed substantial birth cohort effects independent of age, with no clear period effect. Compared with individuals born in 1930, the diagnosed AF incidence rate was 0.125 smaller among individuals born in 1885 and was four times larger among individuals born in 1975.

Conclusion Substantial birth cohort effects, independent of age and calendar period, influence trends in diagnosed AF incidence.

  • Atrial Fibrillation
  • Epidemiology

Data availability statement

Data may be obtained from a third party and are not publicly available. Permission to access the data used in this study can be obtained following approval from the Danish Health Authority and Statistics Denmark.

https://doi.org/10.1136/heartjnl-2023-323737

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    Data availability statement

    Data may be obtained from a third party and are not publicly available. Permission to access the data used in this study can be obtained following approval from the Danish Health Authority and Statistics Denmark.

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    Footnotes

    • Contributors NV, LF, EJB and LT developed the hypothesis. NV, LF and LT developed the study design. NV and LT did the statistical analysis. NV and LT wrote the first and successive drafts of the manuscript. All authors contributed to the analysis and interpretation of data and drafting or critical revision of the manuscript for important intellectual content or additionally to data acquisition. NV had full access to the data and take responsibility for the integrity of the data and the accuracy of the data analysis. NV and LT are the guarantors.

    • Funding This work was supported by a research grant from the Danish Cardiovascular Academy (PD2Y-2022002-DCA), which is funded by the Novo Nordisk Foundation (grant number NNF20SA0067242) and the Danish Heart Foundation.

    • Competing interests NV has served as an advisory board member and consultant for AstraZeneca, no fees were received personally. PC—none. SPJ—co-principal investigator of AFFIRMO, which has received funding from the European Union’s Horizon 2020 research and innovation programme (no 899871); institutional research grant from BMS/Pfizer (not related to the current study); personal consulting fees received from BMS and Pfizer. EJB—R01HL092577; R01AG066010; 1R01AG066914; American Heart Association AF AHA_18SFRN34110082. LF is supported by the Health Research Foundation of Central Denmark Region and has served as a consultant for BMS/Pfizer and AstraZeneca. LT was supported by a research grant from the American Heart Association (18SFRN34150007).

    • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Author note Transparency statement: NV and LT affirm that the manuscript is an honest, accurate and transparent account of the study being reported; that no important aspects of the study have been omitted; and that any discrepancies from the study as originally planned have been explained.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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