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Prior research found that Americans born in 6 southeastern states (the AF-risk zone) had elevated risk of AF-related mortality, but no mechanisms were identified. We hypothesized the association between AF-related mortality and AF-risk zone birth is explained by indicators of childhood social disadvantage or adult risk factors. In 24,323 participants in the US Health and Retirement Study, we found that birth in the AF-risk zone was significantly associated with hazard of AF-related mortality. Among whites, the relationship was specific to place of birth, rather than place of adult residence. Neither paternal education nor subjectively assessed childhood SES predicted AF-related mortality. Conventional childhood and adult cardiovascular risk factors did not explain the association between place of birth and AF-related mortality., (Copyright © 2013 Elsevier Ltd. All rights reserved.)

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., (Copyright © 2011 Elsevier Inc. All rights reserved.)