title: Atrial fibrillation as a cause of death increased steeply in England between 1995 and 2010.
abstract: OBJECTIVE
  To report trends in mortality rates for atrial fibrillation/flutter (AF), using all the certified causes of death mentioned on death certificates (conventionally known as 'mentions') as well as the underlying cause of death, in the national population of England (1995-2010) and in a regional population with longer coverage of all-mentions mortality (1979-2010).
  
  
  RESULTS
  Analysis of death registration data in England and in the Oxford record linkage study. In England between 1995 and 2010, AF was mentioned as a cause of death (either as an underlying cause or as a contributory cause) in 192 770 registered deaths in people aged 45 years of age and over (representing 0.254% of all registered deaths in this age group). Atrial fibrillation was given as the underlying cause of death in 21.4% of all deaths in which it was mentioned (41 298 of 192 770). In England, age-standardized death rates for mentions of AF increased almost three-fold between 1995 and 2010, from 202.5 deaths per million (1995) to 554.1 deaths per million (2010), with an average annual percentage change of 6.6% (95% confidence interval: 6.3, 7.0). Mortality rates for AF did not increase substantially until the mid-1990s: rates in Oxford were 145.4 deaths per million in 1979, 178.1 in 1995, and 505.1 in 2010.
  
  
  CONCLUSIONS
  Atrial fibrillation has become much more common as a certified cause of death. The reasons for this are likely to be multifactorial, with changes in demographics, lifestyle, advances in therapeutics, and altered perception of the importance of the condition by certifying doctors all likely to be contributing factors.
authors.affiliation: Unit of Health-Care Epidemiology, Nuffield Department of Population Health, University of Oxford, Old Road Campus, Oxford OX3 7LF, UK marie.duncan@dph.ox.ac.uk.
authors.forename: Marie E
authors.initials: ME
authors.lastname: Duncan
authors.affiliation: Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, John Radcliffe Hospital, Headington, Oxford OX3 9DU, UK.
authors.forename: Alex
authors.initials: A
authors.lastname: Pitcher
authors.affiliation: Unit of Health-Care Epidemiology, Nuffield Department of Population Health, University of Oxford, Old Road Campus, Oxford OX3 7LF, UK.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Goldacre
mesh_terms: D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D001281:Atrial Fibrillation / Q000401:mortality*; D001282:Atrial Flutter / Q000401:mortality*; D002423:Cause of Death / Q000639:trends; D003644:Death Certificates; D004739:England / Q000453:epidemiology; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D012042:Registries; D018570:Risk Assessment; D017678:Sex Distribution; D015996:Survival Rate
keywords: Atrial fibrillation; Death certification; England; Mortality