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Lower Prevalence than Expected when Screening 70-year-old Men for Abdominal Aortic Aneurysm
Linköping University, Department of Medical and Health Sciences, Physiology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Thoracic and Vascular Surgery.
Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Thoracic and Vascular Surgery.ORCID iD: 0000-0002-9095-403X
Linköping University, Department of Medical and Health Sciences, Division of Health Care Analysis. Linköping University, Faculty of Health Sciences.
Linköping University, Department of Medical and Health Sciences, Physiology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Thoracic and Vascular Surgery.
2013 (English)In: European Journal of Vascular and Endovascular Surgery, ISSN 1078-5884, E-ISSN 1532-2165, Vol. 46, no 4, 453-459 p.Article in journal (Refereed) Published
Abstract [en]

Background

Screening 65-year-old men for abdominal aortic aneurysms (AAA) is a cost-effective method to reduce the mortality from ruptured AAA. However, contemporary results show a lower than expected prevalence of AAA, thus questioning the benefit of screening. Since the prevalence increases with age, a possible way to enhance the benefit of screening might be to screen older men. Our aim was to determine the contemporary screening-detected prevalence among 70-year-old men.

Methods

A total of 5,623 unscreened 70-year-old men were invited to ultrasound screening. Uni- and multivariable analyses were used to assess the risk factors for AAA.

Results

The attendance rate was 84.0%. The prevalence of previously unknown AAAs was 2.3%. When adding the 64 men with an already known AAA to the screening-detected ones, the total prevalence in the population was at least 3.0%, and the previously discovered AAAs constituted 37.4% of the total prevalence. “Ex smoker” and “Current smoker” were the most important risk factors.

Conclusions

When screening 70-year-old men for AAA, the prevalence was less than half that expected, despite a high attendance rate. Smoking was the strongest risk factor. Almost 40% of the men with AAAs were already known from other means than screening.

Place, publisher, year, edition, pages
2013. Vol. 46, no 4, 453-459 p.
Keyword [en]
Abdominal aortic aneurysm, Screening, Prevalence, Attendance rate, Swedvasc
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:liu:diva-102089DOI: 10.1016/j.ejvs.2013.07.014ISI: 000326408400012OAI: oai:DiVA.org:liu-102089DiVA: diva2:668924
Note

Funding Agencies|Swedish Heart-Lung Foundation||King Gustav V and Queen Victorias foundation||

Available from: 2013-12-02 Created: 2013-11-29 Last updated: 2017-12-06
In thesis
1. Abdominal Aortic Aneurysm: Aspects on how to affect mortality from rupture
Open this publication in new window or tab >>Abdominal Aortic Aneurysm: Aspects on how to affect mortality from rupture
2014 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Abdominal Aortic Aneurysm (AAA) is a disease that mainly affects elderly men, and ruptured AAA (rAAA) is associated with a mortality of > 80%. AAA seldom gives any symptoms prior to rupture.

The aims of this thesis were to investigate different aspects of how to affect mortality from rAAA.

In Study I, we identified 849 patients treated for rAAA during 1987-2004, and studied the 30-day survival after surgery, depending on whether they came directly to the treating hospital (one-stop) or were transferred via another hospital (two-stop). A two-stop referral pattern resulted in a 27% lower population-based survival rate for patients 65-74 years of age. However, the consequences would be small even if a one-stop referral pattern could be generally accomplished, due to the huge over-all mortality related to rAAA, hence an argument to find and treat AAA before rupture, e.g. by screening.

In Study II, we examined the AAA-prevalence and the risk factors for AAA among 70-year-old men. The screening-detected AAA-prevalence was 2.3%, thus less than half the predicted. The most important risk factor was smoking.

In Study III, we compared the screening-detected AAA-prevalence, the attendance rate, and the rate of opportunistic detection of AAA, between almost 8000 65- and 6000 70-year-old men. There was no difference in the screening-detected prevalence; probably due to the fact that almost 40% of the AAAs among the 70-year-old were already known prior to screening, compared to roughly 25% in the 65-year-old. The attendance rate was higher among the 65-year-old men, 85.7% compared 84.0% in the 70-year-old. Thus, there is no benefit of screening for AAA among 70- instead of 65-year-old men.

In Study IV, a cost-effectiveness analysis, we found that screening for AAA still appears to be cost-effective, despite profound changes in disease pattern and AAA-management.

In conclusion, we found that mortality from rAAA is not affected in any substantial way by different referral patterns and hence centralisation of services for AAA/rAAA is not a solution. A better alternative is to prevent rupture through early detection by screening. Screening 65-year-old men for AAA still appears to be cost-effective, despite profound changes in disease pattern and AAA-management during the last decade. Screening 70- instead of 65-year-old men will not increase the efficacy of screening.

Place, publisher, year, edition, pages
Linköping: Linköping University Electronic Press, 2014. 113 p.
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 1381
Keyword
abdominal aortic aneurysm rupture AAA rAAA screening one-stop two stop prevalence risk factor cost-effectiveness
National Category
Surgery
Identifiers
urn:nbn:se:liu:diva-102482 (URN)10.3384/diss.diva-102482 (DOI)978-91-7519-503-2 (ISBN)
Public defence
2014-01-31, Berzeliussalen, Campus US, Linköpings universitet, Linköping, 13:00 (Swedish)
Opponent
Supervisors
Funder
Swedish Heart Lung FoundationCounty Council of Östergötland
Available from: 2014-01-08 Created: 2013-12-12 Last updated: 2017-03-27Bibliographically approved

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Hager, JakobLänne, TosteCarlsson, PerLundgren, Fredrik

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European Journal of Vascular and Endovascular Surgery
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