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March 18, 2026BMC Public Health0 citationsOpen Access

Mortality trends in older adults (55–84 years) with sepsis-atrial fibrillation: a CDC database analysis

JLJiahang LiYLYadong LongBXBitao Xiang

Key Result

Age-adjusted mortality rates for US adults aged 55-84 with sepsis and atrial fibrillation increased significantly by 145% from 0.64 to 1.57 per 100,000 between 1999 and 2020.

Key Points

  • The aim is to investigate mortality trends and disparities in older adults with sepsis and atrial fibrillation (AF).
  • Analyzed CDC WONDER mortality data from 1999 to 2020 for adults aged 55-84 years.
  • Defined cases using death certificates indicating sepsis as the underlying cause and AF as a contributing condition.
  • Calculated age-adjusted mortality rates (AAMR) based on the 2000 US standard population.
  • Assessed temporal trends in AAMR using Joinpoint regression, stratified by race and region.
  • Overall AAMR increased significantly from 0.64 to 1.57 per 100,000, a rise of 145%.
  • Males had a 30.7% higher mortality rate than females by 2020.
  • Black individuals had higher mean AAMR throughout the study but rates converged by 2020.
  • The South recorded the highest AAMR while the West showed the largest relative increase.
  • AAMR surged across all groups in 2020, coinciding with the COVID-19 pandemic.

Study Design

Type

Observational (n=15,442)

Structured PICO

P
Population
Adults aged 55–84 years with sepsis as the underlying cause of death and atrial fibrillation (AF) as a contributing condition
O
Outcome
Age-adjusted mortality rate (AAMR) for deaths associated with sepsis-AFhard clinical

Mortality due to sepsis-AF among older adults in the US has exhibited a sustained upward trajectory from 1999 to 2020, accompanied by significant demographic and regional disparities.

Main Result

Effect estimate: AAPC 4.49% (95% CI 4.17%-4.89%)

Absolute Event Rate: 1.57% vs 0.64%

p-value: p=<0.001

Limitations

  • Definition may miss deaths where sepsis was coded as a contributing cause rather than the underlying cause
  • Racial analysis was primarily limited to non-Hispanic White and Black populations due to insufficient cases in other groups
  • Aggregated nature of the data prevented quantitative disentanglement of deaths directly attributable to COVID-19 in 2020
  • Cannot infer individual-level clinical characteristics, treatment responses, or specific death mechanisms
  • Exclusion of adults >84 years limits generalizability to the ultra-elderly population
  • Aggregated nature of mortality data precludes distinguishing between deaths directly attributable to COVID-19, indirect effects of healthcare system strain, or changes in death certification practices
  • Results represent trends in reported mortality rather than direct measures of clinical disease progression or incidence at the individual level

Abstract

Sepsis is a leading cause of mortality among older adults, and atrial fibrillation (AF), as a common comorbidity, significantly increases the risk of adverse outcomes. This study aimed to investigate nationwide mortality trends, racial and regional disparities, and contributing factors in adults aged 55–84 years with sepsis-AF. We analyzed CDC WONDER mortality data for adults aged 55–84 years (1999–2020), defining cases as deaths with sepsis (A40–A41) as the underlying cause and AF (I48) listed as a contributing condition anywhere on the certificate. Individuals aged 55–84 years with sepsis-AF noted on death certificates were included. Age-adjusted mortality rates (AAMR) were calculated based on the 2000 US standard population. Temporal trends in AAMR were assessed using Joinpoint regression, and analyses were stratified by race and geographic region. The overall AAMR increased significantly from 0.64 to 1.57 per 100,000 (145% rise; average annual percent change AAPC = 4.49%). Marked disparities were observed: males exhibited 30.7% higher mortality than females by 2020; Black individuals showed higher mean AAMR throughout the study period though rates converged statistically by 2020; and the South recorded the highest regional AAMR while the West showed the largest relative increase. AAMR surged across all groups in 2020, coinciding with the COVID-19 pandemic. Mortality due to sepsis-AF among older adults aged 55–84 years in the US has exhibited a sustained upward trajectory, accompanied by significant demographic and regional disparities. Targeted public health interventions are essential to address these inequalities and mitigate mortality in high-risk populations.

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Cite This Study

Li et al. (2026) conducted an observational in Sepsis-Atrial Fibrillation (n=15,442). Age-adjusted mortality rates for US adults aged 55-84 with sepsis and atrial fibrillation increased significantly by 145% from 0.64 to 1.57 per 100,000 between 1999 and 2020.

synapsesocial.com/papers/69ba434a4e9516ffd37a4609https://doi.org/10.1186/s12889-026-27023-x
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