By 2009, screening programs had been implemented in five contiguous counties of central Sweden. Every 3 months, 65-year-old men in these counties are identified by using a national population registry and are then invited to a one-time ultrasound examination of the abdominal aorta. In 2009, these five counties comprised 15% of Sweden's population (1,404,978 individuals). In this study, the authors report their results of screening 65-year-old men for AAA in middle Sweden. All 65-year-old men (n ϭ 26,256) in the five-county area of middle Sweden were identified through a national population registry and were invited for an ultrasound examination of the abdominal aorta. An AAA was defined as a maximum infrarenal aortic diameter Ն30 mm. Of the 22,187 invited for the screening, 85% accepted the invitation and 373 AAAs (1.7%, 95% CI, 1.5%-1.9%) were detected. If one included 127 previously known AAAs repaired or under surveillance, the total prevalence of AAA in the population was 2.2% (95% CI, 2.0%-2.4%). Independent associations from a multivariate logistic regression model with AAA were self-reported smoking (OR, 3.4; P Ͻ .001), coronary artery disease (OR, 2.0; P Ͻ .001), and hypertension (OR, 1.6; P ϭ .001). In the five-county population, 13% of inhabitants were self-reported to be current smokers, one-third the frequency reported in the 1980s. Comment: The population-based study design and high participation in the screening program (85%) suggests the results of this study are generally applicable at least to the Swedish population. The prevalence of the AAA in this study is one-half to one-third of that reported elsewhere and parallels a dramatic reduction in the prevalence of smoking. The decreased prevalence of smoking combined with the significant increase in life expectancy of the male population at risk for AAA has implications for AAA screening programs. On the basis of what is apparently a decreased prevalence of disease and decreased risk factors, cost-effectiveness and protocols of current screening programs may need to be reevaluated.

Background-Screening elderly men with ultrasound is an established method to reduce mortality from ruptured abdominal aortic aneurysm (AAA; Evidence Level 1a). Such programs are being implemented and generally consist of a single scan at 65 years of age. We report the results from screening 65-year-old men for AAA in middle Sweden. Methods and Results-All 65-year-old men (nϭ26 256), identified through the National Population Registry, were invited to an ultrasound examination. An AAA was defined as a maximum infrarenal aortic diameter of Ն30 mm. In total, 22 187 (85%) accepted, and 373 AAAs were detected (1.7%; 95% confidence interval, 1.5 to 1.9). With 127 previously known AAAs (repaired/under surveillance) included, the total prevalence of the disease in the population was 2.2% (95% confidence interval, 2.0 to 2.4). Self-reported smoking (odds ratio, 3.4; PϽ0.001), coronary artery disease (odds ratio, 2.0; PϽ0.001), and hypertension (odds ratio, 1.6; Pϭ0.001) were independently associated with AAA in a multivariate logistic regression model. Thirteen percent of the entire population reported to be current smokers, one third of the frequency reported in the 1980s. The observed low prevalence of AAA was explained mainly by this change in smoking habits. Conclusions-On the basis of the observed reduced exposure to risk factors, lower-than-expected prevalence of AAA among 65-year-old men, unchanged AAA repair rate, and significantly improved longevity of the elderly population, the current generally agreed-on AAA screening model can be questioned. Important issues to address are the threshold diameter for follow-up, the possible need for rescreening at a higher age, and selective screening among smokers. (Circulation.

Screening 65-year-old men for AAA is an effective preventive health measure and is highly cost-effective in a contemporary setting. These findings confirm the results from earlier randomized controlled trials and model studies in a large population-based setting of the importance for future healthcare decision making.

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