title: Relative and absolute risks of all-cause and cause-specific deaths attributable to atrial fibrillation in middle-aged and elderly community dwellers.
abstract: BACKGROUND
  The relative and absolute risks of outcomes other than all-cause death (ACD) attributable to atrial fibrillation (AF) stratified age have not been sufficiently investigated.
  
  
  METHODS
  A prospective study of 23,634 community dwellers aged 40 years or older without organic cardiovascular disease (AF=335, non-AF=23,299) was conducted. Multivariate-adjusted rates, rate ratios (RRs) and excess deaths (EDs) for ACD, cardiovascular death (CVD) and non-cardiovascular death (non-CVD), and sex- and age-adjusted RR and ED in middle-aged (40 to 69) and elderly (70 years or older) for ACD, CVD, non-CVD, sudden cardiac death (SCD), stroke-related death (Str-D), neoplasm-related death (NPD), and infection-related death (IFD) attributable to AF were estimated using Poisson regression.
  
  
  RESULTS
  Multivariate-adjusted analysis revealed that AF significantly increased the risk of ACD (RR [95% confidence interval]:1.70 [1.23-2.95]) and CVD (3.86 [2.38-6.27]), but not non-CVD. Age-stratified analysis revealed that AF increased the risk of Str-D in middle-aged (14.5 [4.77-44.3]) and elderly individuals (4.92 [1.91-12.7]), SCD in elderly individuals (3.21 [1.37-7.51]), and might increase the risk of IFD in elderly individuals (2.02 [0.80-4.65], p=0.098). The RR of CVD was higher in middle-aged versus elderly individuals (RRs, 6.19 vs. 3.57) but the absolute risk difference was larger in elderly individuals (EDs: 7.6 vs. 3.0 per 1000 person-years).
  
  
  CONCLUSIONS
  Larger absolute risk differences for ACD and CVD attributable to AF among elderly people indicate that the absolute burden of AF is higher in elderly versus middle-aged people despite the relatively small RR.
authors.affiliation: Department of Hygiene and Preventive Medicine, Iwate Medical University, Japan. Electronic address: masakio@iwate-med.ac.jp.
authors.forename: Masaki
authors.initials: M
authors.lastname: Ohsawa
authors.affiliation: Department of Preventive Medicine and Public Health, Keio University, Tokyo, Japan.
authors.forename: Tomonori
authors.initials: T
authors.lastname: Okamura
authors.affiliation: Department of Neurosurgery, Iwate Medical University, Morioka, Japan.
authors.forename: Kuniaki
authors.initials: K
authors.lastname: Ogasawara
authors.affiliation: Department of Neurosurgery, Iwate Medical University, Morioka, Japan.
authors.forename: Akira
authors.initials: A
authors.lastname: Ogawa
authors.affiliation: Department of Urology, Iwate Medical University, Morioka, Japan.
authors.forename: Tomoaki
authors.initials: T
authors.lastname: Fujioka
authors.affiliation: Department of Hygiene and Preventive Medicine, Iwate Medical University, Japan.
authors.forename: Kozo
authors.initials: K
authors.lastname: Tanno
authors.affiliation: Department of Hygiene and Preventive Medicine, Iwate Medical University, Japan.
authors.forename: Yuki
authors.initials: Y
authors.lastname: Yonekura
authors.affiliation: Department of Neurosurgery, Iwate Medical University, Morioka, Japan.
authors.forename: Shinichi
authors.initials: S
authors.lastname: Omama
authors.affiliation: Department of Community Health Sciences, University of Calgary, Canada.
authors.forename: Tanvir Chowdhury
authors.initials: TC
authors.lastname: Turin
authors.affiliation: Department of Nutritional Sciences, Morioka University, Takizawa, Japan.
authors.forename: Kazuyoshi
authors.initials: K
authors.lastname: Itai
authors.affiliation: Department of Internal Medicine, Iwate Medical University, Morioka, Japan.
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Ishibashi
authors.affiliation: Department of Internal Medicine, Iwate Medical University, Morioka, Japan.
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Morino
authors.affiliation: Department of Internal Medicine, Iwate Medical University, Morioka, Japan.
authors.forename: Tomonori
authors.initials: T
authors.lastname: Itoh
authors.affiliation: Department of Clinical Nursing, Shiga University of Medical Science, Otsu, Japan.
authors.forename: Naomi
authors.initials: N
authors.lastname: Miyamatsu
authors.affiliation: Department of Hygiene and Preventive Medicine, Iwate Medical University, Japan.
authors.forename: Toshiyuki
authors.initials: T
authors.lastname: Onoda
authors.affiliation: Department of Health and Physical Education, Faculty of Education, Iwate University, Morioka, Japan.
authors.forename: Toru
authors.initials: T
authors.lastname: Kuribayashi
authors.affiliation: Department of Internal Medicine, Iwate Medical University, Morioka, Japan.
authors.forename: Shinji
authors.initials: S
authors.lastname: Makita
authors.affiliation: Department of Neurosurgery, Iwate Medical University, Morioka, Japan.
authors.forename: Yuki
authors.initials: Y
authors.lastname: Yoshida
authors.affiliation: Department of Internal Medicine, Iwate Medical University, Morioka, Japan.
authors.forename: Motoyuki
authors.initials: M
authors.lastname: Nakamura
authors.affiliation: Department of Internal Medicine, Iwate Medical University, Morioka, Japan.
authors.forename: Fumitaka
authors.initials: F
authors.lastname: Tanaka
authors.affiliation: Iwate Health Service Association, Morioka, Japan.
authors.forename: Mutsuko
authors.initials: M
authors.lastname: Ohta
authors.affiliation: Department of Hygiene and Preventive Medicine, Iwate Medical University, Japan.
authors.forename: Kiyomi
authors.initials: K
authors.lastname: Sakata
authors.affiliation: The Research Institute of Strategy for Prevention, Tokyo, Japan.
authors.forename: Akira
authors.initials: A
authors.lastname: Okayama
mesh_terms: D000368:Aged; D001281:Atrial Fibrillation / Q000175:diagnosis* / Q000401:mortality*; D002423:Cause of Death / Q000639:trends*; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D057187:Independent Living / Q000639:trends*; D007564:Japan / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012307:Risk Factors
keywords: Absolute risk difference; Atrial fibrillation; Cardiovascular death; Non-cardiovascular death; Relative risk; Sudden cardiac death