High dead tuple ratio causes table bloat and slow queries

Tables with dead tuple ratio above 10% experience bloat and degraded query performance. Dead tuples accumulate from updates and deletes when autovacuum cannot keep up. Threshold: alert when dead_tuple_ratio > 10%.

Run manual VACUUM ANALYZE on affected tables. Tune per-table autovacuum settings: reduce autovacuum_vacuum_scale_factor from 0.2 to 0.01, increase autovacuum_max_workers from 3 to 5-6. For high-churn tables, set autovacuum_vacuum_cost_delay to 2.