摘要BACKGROUND Atrial fibrillation(AF)is a common cardiac arrhythmia in the elderly.This study aimed to evaluate urban-ru-ral disparities in its prevalence and management in elderly Chinese.METHODS Consecutive participants aged ≥ 65 years attending outpatient clinics were enrolled for AF screening using hand-held single-lead electrocardiogram(ECG)from April 2017 to December 2022.Each ECG rhythm strip was reviewed from the res-earch team.AF or uninterpretable single-lead ECGs were referred for 12-lead ECG.Primary study outcome comparison was bet-ween rural and urban areas for the prevalence of AF.The Student's t-test was used to compare mean values of clinical characteri-stics between rural and urban participants,while the Pearson's chi-square test was used to compare between-group proportions.Multivariate stepwise logistic regression analysis was performed to estimate the association between AF and various patient char-acteristics.RESULTS The 29,166 study participants included 13,253 men(45.4％)and had a mean age of 72.2 years.The 7073 rural parti-cipants differed significantly(P ≤ 0.02)from the 22,093 urban participants in several major characteristics,such as older age,grea-ter body mass index,and so on.The overall prevalence of AF was 4.6％(n=1347).AF was more prevalent in 7073 rural partici-pants than 22,093 urban participants(5.6％vs.4.3％,P＜0.01),before and after adjustment for age,body mass index,blood pressu-re,pulse rate,cigarette smoking,alcohol consumption and prior medical history.Multivariate logistic regression analysis identif-ied overweight/obesity(OR=1.35,95％CI:1.17-1.54)in urban areas and cigarette smoking(OR=1.62,95％CI:1.20-2.17)and alco-hol consumption(OR=1.42,95％CI:1.04-1.93)in rural areas as specific risk factors for prevalent AF.In patients with known AF in urban areas(n=781)and rural areas(n=338),60.6％and 45.9％,respectively,received AF treatment(P＜0.01),and only 22.4％and 17.2％,respectively,received anticoagulation therapy(P=0.05).CONCLUSIONS In China,there are urban-rural disparities in AF in the elderly,with a higher prevalence and worse manage-ment in rural areas than urban areas.Our study findings provide insight for health policymakers to consider urban-rural dispari-ty in the prevention and treatment of AF.