Abstract
Introduction: Atrial fibrillation (AF) increases the risk of anticoagulation-associated intracerebral hemorrhage (ICH), yet contemporary national mortality trends specific to this overlap remain undercharacterized. Temporal, demographic, and geographic trends in ICH mortality among patients with concomitant AF in the United States from 1999 to 2025, with projections to 2040, were examined. Methods: A retrospective analysis of death certificate data from the Centers for Disease Control and Prevention Wide-ranging Online Data for Epidemiologic Research (CDC WONDER) database was conducted, identifying deaths listing ICH (International Classification of Diseases, Tenth Revision [ICD-10] code I61) and AF (ICD-10 code I48) in any cause-of-death field. Age-adjusted mortality rates were calculated per 100,000 population and stratified by sex, race/ethnicity, census region, and urbanization. Joinpoint regression assessed temporal trends, and autoregressive integrated moving average (ARIMA) models projected rates through 2040. Results: From 1999 to 2025, 52,967 deaths were identified. The overall age-adjusted mortality rate rose from 0.4 to 0.7 per 100,000 between 1999 and 2021 (annual percent change [APC] 1.53%, p=0.016) before stabilizing through 2025. Mortality was consistently higher among men and rose significantly across the study period among Black or African American individuals (APC 1.83%, p<0.000001). Nonmetropolitan areas and the West and South regions carried the highest burden, while the Northeast declined after 2015. State rates ranged from 0.3 in Louisiana to 1.1 in Vermont, and most deaths occurred in medical facilities. Conclusions: Mortality from ICH among patients with AF rose substantially before stabilizing, with persistent disparities by sex, race, and geography. Projections through 2040 indicate stable rates but a growing absolute burden, underscoring the need for equitable hypertension control and anticoagulation management.