Temporal trends in associations between social drivers and life-years lost in newly diagnosed atrial fibrillation in Denmark, 2000-22: a nationwide cohort study.

BACKGROUND

Individuals with atrial fibrillation who are systemically disadvantaged often receive lower quality of care and face higher complications and mortality rates. However, data on survival inequity trends are sparse. We examined temporal trends in associations between social drivers and life expectancy loss among individuals with newly diagnosed atrial fibrillation in Denmark.

METHODS

In this nationwide, registry-based, cohort study, we assessed mortality in individuals with newly diagnosed atrial fibrillation. Social drivers at diagnosis included family income (lower, medium, higher), educational attainment (lower, medium, higher), and living alone. For each social driver, we compared age-adjusted and sex-adjusted 10-year restricted mean time lost across subgroups as an absolute measure of inequity in expected survival time. Trends were compared between the periods of 2000-10 and 2011-22.

FINDINGS: Among 383 566 individuals with newly diagnosed atrial fibrillation, restricted mean time lost improved across all levels of social drivers over time. Life-years lost associated with income changed modestly between periods, with a slight reduction in inequity for people with medium versus higher income (-1·65 years [95% CI -1·70 to -1·60] to -1·55 years [-1·59 to -1·50]), but a slight increase for people with lower versus higher income (-2·46 years [-2·55 to -2·37] to -2·51 years [-2·57 to -2·45]; Pinteraction=0·002). The loss associated with education improved between periods (medium versus higher: -0·77 years [-0·83 to -0·71] to -0·63 years [-0·67 to -0·58]; lower versus higher: -1·81 years [-1·87 to -1·75] to -1·75 years [-1·80 to -1·70]; Pinteraction<0·001). Life-years lost associated with living alone worsened between periods (-1·48 years [-1·52 to -1·44] to -1·56 years [-1·60 to -1·53]; Pinteraction=0·002).

INTERPRETATION: Despite small improvements for income and education, substantial socioeconomic inequities in long-term survival after atrial fibrillation diagnosis persisted over two decades. The findings highlight the urgent need to address the underlying barriers driving the inequities.

FUNDING: Danish Cardiovascular Academy.