Early-life antecedents of atrial fibrillation: place of birth and atrial fibrillation-related mortality

Ann Epidemiol. 2011 Oct;21(10):732-8. doi: 10.1016/j.annepidem.2011.06.003. Epub 2011 Jul 27.


Purpose: Recent evidence suggests early-life factors correlate with atrial fibrillation (AF). We hypothesized that AF-related mortality, similar to stroke mortality, is elevated for individuals born in the southeastern United States.

Methods: We estimated 3-year (1999-2001) average AF-related mortality rates by using U.S. vital statistics for 55- to 89-year-old white (136,573 AF-related deaths) and black subjects (8,288 AF-related deaths). We estimated age- and sex-adjusted odds of AF-related (contributing cause) mortality associated with birth state, and birth within the U.S. stroke belt (SB), stratified by race. SB results were replicated with the use of 1989-1991 data.

Results: Among black subjects, four contiguous birth states were associated with statistically significant odds ratios ≥ 1.25 compared with the national average AF-related mortality. The four highest-risk birth states for blacks also predicted elevated AF-related mortality among white subjects, but patterns were attenuated. The odds ratio for AF-related mortality associated with SB birth was 1.19 (confidence interval 1.13-1.25) for black and 1.09 (CI 1.07-1.12) for white subjects when we adjusted for SB adult residence.

Conclusions: Place of birth predicted AF-related mortality, after we adjusted for place of adult residence. The association of AF-related mortality and SB birth parallels that of other cardiovascular diseases and may likewise indicate an importance of early life factors in the development of AF.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • African Americans / statistics & numerical data*
  • Aged
  • Aged, 80 and over
  • Atrial Fibrillation / ethnology*
  • Atrial Fibrillation / mortality*
  • Female
  • Geography / statistics & numerical data*
  • Humans
  • Male
  • Middle Aged
  • Residence Characteristics / statistics & numerical data
  • Risk Factors
  • Southeastern United States / epidemiology
  • Whites / statistics & numerical data*