The prevalence and incidence rate of atrial fibrillation (AF) increase worldwide and AF is a risk factor for more adverse cardiovascular diseases including stroke. Approximately 44% of AF cases cannot be explained by common individual risk factors and risk might therefore also be related to the environment. By studying geographical variation and clustering in risk of incident AF adjusted for socioeconomic position at an individual level, potential neighbourhood risk factors could be revealed. Initially, yearly AF incidence rates 1987–2015 were estimated overall and stratified by income in a register-based cohort study. To examine geographical variation and clustering in AF, we used both spatial scan statistics and a hierarchical Bayesian Poisson regression analysis of AF incidence rates with random effect of municipalities (n = 98) in Denmark in 2011–2015. The 1987–2015 cohort included 5,453,639 individuals whereof 369,800 were diagnosed with an incident AF. AF incidence rate increased from 174 to 576 per 100,000 person-years from 1987 to 2015. Inequality in AF incidence rate ratio between highest and lowest income groups increased from 23% in 1987 to 38% in 2015. We found clustering and geographical variation in AF incidence rates, with incidence rates at municipality level being up to 34% higher than the country mean after adjusting for socioeconomic position. Geographical variations and clustering in AF incidence rates exist. Compared to previous studies from Alberta, Canada and the United States, we show that geographical variations exist in a country with free access to healthcare and even when accounting for socioeconomic differences at an individual level. An increasing social inequality in AF was seen from 1987 to 2015. Therefore, when planning prevention strategies, attention to individuals with low income should be given. Further studies focusing on identification of neighbourhood risk factors for AF are needed.

中文翻译：

---

除社会经济差异外，在房颤中发现了地理变异和聚类：丹麦队列研究，1987–2015年

心房颤动（AF）的患病率和发病率在全世界范围内都在增加，而AF是包括卒中在内的更多不良心血管疾病的危险因素。大约44％的房颤病例无法用常见的个人危险因素来解释，因此危险也可能与环境有关。通过研究地理变异和个体房颤风险的聚类，并根据个人的社会经济状况进行了调整，可以揭示潜在的邻里风险因素。最初，在基于注册的队列研究中，对1987-2015年的每年房颤发生率进行了总体估算，并按收入进行了分层。要检查AF中的地理差异和聚类，我们使用了空间扫描统计数据和AF发生率的贝叶斯Poisson分层分析，并在2011-2015年丹麦的自治市（n = 98）中产生了随机效应。1987-2015年队列中包括5,453,639个人，其中369,800被诊断为房颤事件。从1987年到2015年，房颤的发生率从100,000人年的174增加到576。最高和最低收入组之间房颤的发生率之比从1987年的23％增加到2015年的38％。我们发现房颤的聚类和地理差异发病率，根据社会经济地位调整后，市政当局的发病率比该国平均水平高34％。存在AF发生率的地理变化和聚类。与先前的艾伯塔省，加拿大和美国的研究相比，我们表明，即使免费考虑个人层面的社会经济差异，一个拥有免费医疗服务的国家也存在地域差异。从1987年到2015年，房颤的社会不平等现象加剧。因此，在制定预防策略时，应注意低收入人群。需要进行进一步的研究，侧重于确定房颤的危险因素。