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Current prevalence of abdominal aortic aneurysm in 70-year-old women
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Vascular Surgery.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Vascular Surgery.ORCID iD: 0000-0001-6561-9734
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Vascular Surgery.
2013 (English)In: British Journal of Surgery, ISSN 0007-1323, E-ISSN 1365-2168, Vol. 100, no 3, 367-372 p.Article in journal (Refereed) Published
Abstract [en]

BACKGROUND:

Screening elderly men for abdominal aortic aneurysm (AAA) to reduce mortality from rupture is evidence-based. For women epidemiological data on AAA are scarce, and the evidence for screening is insufficient. The aim of this population-based study was to determine the current prevalence of AAA and risk factors among 70-year-old women.

METHODS:

All 70-year-old women identified through the National Population Registry in the two neighbouring counties of Uppsala and Dalarna were invited to a free ultrasound examination of the abdominal aorta. An AAA was defined as a maximum infrarenal aortic diameter of at least 30 mm.

RESULTS:

Of 6925 women invited, 5140 (74·2 per cent) accepted the invitation to be screened. Among these, 19 AAAs were detected (0·4 (95 per cent confidence interval (c.i.) 0·2 to 0·5) per cent). In the invited cohort 12 women (0·2 (0·1 to 0·3) per cent) had undergone previous AAA repair (11) or had a known AAA under surveillance (1). Thus, the total prevalence was estimated at 0·5 (0·4 to 0·7) per cent. Smoking was strongly associated with AAA; 18 (95 per cent) of 19 women with a screen-detected AAA had a history of smoking compared with 44·2 per cent of those with a normal aorta (odds ratio 20·29, 95 per cent c.i. 2·70 to 152·65). The prevalence of AAA was 0·03 (0 to 0·1) per cent among never smokers, 0·4 (0·2 to 0·8) per cent among former smokers and 2·1 (1·0 to 3·7) per cent among current smokers.

CONCLUSION:

Screening 70-year-old women who do not smoke is likely to be futile, thus ruling out population screening of women for AAA.

Place, publisher, year, edition, pages
2013. Vol. 100, no 3, 367-372 p.
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:uu:diva-188850DOI: 10.1002/bjs.8984ISI: 000313531100011PubMedID: 23192439OAI: oai:DiVA.org:uu-188850DiVA: diva2:579375
Available from: 2012-12-20 Created: 2012-12-20 Last updated: 2017-12-06Bibliographically approved
In thesis
1. Screening for Abdominal Aortic Aneurysm
Open this publication in new window or tab >>Screening for Abdominal Aortic Aneurysm
2013 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Randomised controlled trials have demonstrated that mortality from Abdominal Aortic Aneurysm (AAA) can be cost-effectively reduced by ultrasound-screening of men. Evidence for screening women is insufficient. Reports of falling AAA incidence are emerging.

In an effort to study screening for AAA in a contemporary setting, two cross-sectional multi-centre population-based studies of one-time screening of 65-year-old men, and 70-year-old women in Middle Sweden were undertaken. Cost-efficiency of one-time screening of 65-year-old men was evaluated in a decision-analysis model. Five-year outcomes in men invited to screening at age 65 and age 70, were studied in a longitudinal cohort study.

A lower than expected (1.7%) prevalence of AAA in 65-year-old men was found, as well as a very low (0.4%) prevalence in 70-year-old women. Smoking was the dominating risk factor associated with AAA, but the association was stronger in women. The main cause of reduced contemporary prevalence was falling smoking rates in the population since 30 years.

One-time screening of 65-year-old men was found to be cost-effective and deliver significant clinical impact. The cost per quality adjusted life-year gained, at 13-years follow-up, was €14706, which was below the recommended UK NICE threshold of €25000. 15 lives were saved by inviting 10000 to screening. Prevalence of AAA and the rate of incidental detection of AAAs in the population were important factors affecting cost-efficiency.

New AAAs developed after 5 years in men screened normal at age 65, predominantly in men with sub-aneurysmal aortas (25-29mm) at 65, and smokers. The 5-year rate of AAA repair was high among men with screening detected AAAs, as was non-AAA related mortality. Ruptures were only documented among non-attenders.

Conclusions: A lower than expected prevalence of AAA among 65-year-old men, an unchanged repair rate, and improved longevity of the elderly population was found. Although one-time screening for AAA was still cost-effective within a contemporary context, several issues need to be addressed; the threshold diameter for follow-up, the current rate of opportunistic detection of AAA in the population, re-screening of the entire population at a higher age, and targeted screening of smokers. Screening 70-year-old women who do not smoke is likely to be futile, thus ruling out population screening of women for AAA.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2013. 82 p.
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 903
National Category
Surgery
Identifiers
urn:nbn:se:uu:diva-198677 (URN)978-91-554-8668-6 (ISBN)
Public defence
2013-06-07, Föreläsningssalen, Falu Lasarett, Entré 6:C 01, Söderbaums väg 8, Falun, 13:15 (English)
Available from: 2013-05-17 Created: 2013-04-22 Last updated: 2013-08-30Bibliographically approved

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Svensjö, SverkerBjörck, MartinWanhainen, Anders

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