Geography, private costs and uptake of screening for abdominal aortic aneurysm in a remote rural area

Lindsay, Sandra; Duncan, J.L.; Cairns, John; Godden, D. J.

doi:10.1186/1471-2458-6-80

Cited by 5 publications

(5 citation statements)

References 32 publications

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“…However, 4.5% of men with an aortic diameter of 25-29 mm had a hospital admission with an aneurysm diagnosis during follow-up, such presentations becoming noticeable from two years after screening, supporting the concept of repeat screening in the 25-29 mm group. The association between aneurysm and cardiovascular disease that we observed has been shown in several studies 1618 19 In the Tromso study,15 an abdominal aortic aneurysm at baseline conferred a 2.5-fold increase in cardiovascular mortality over 10 years, compared with a 1.88-fold increased risk in our study.…”

Section: Discussionsupporting

confidence: 79%

“…The association between aneurysm and cardiovascular disease that we observed has been shown in several studies. 16 18 19 In the Tromso study, 15 an abdominal aortic aneurysm at baseline conferred a 2.5-fold increase in cardiovascular mortality over 10 years, compared with a 1.88-fold increased risk in our study. One study followed up 4734 men and women aged over 65 for 10 years.…”

Section: Discussioncontrasting

confidence: 44%

“…The reasons for our lower mortality, apart from differences in age, are unclear, although may reflect improving cardiovascular risk prevention and the relatively rural nature of our cohort. 13 16 The risk of death from aneurysm in our cohort was low. In total, 11 deaths were reported as being due to aneurysm, representing 0.14% of the cohort and 1.7% of all deaths.…”

Section: Discussionmentioning

confidence: 66%

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Long term outcomes in men screened for abdominal aortic aneurysm: prospective cohort study

Duncan

Harrild

Iversen

et al. 2012

BMJ

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Objective To determine whether there is a relation between aortic diameter and morbidity and mortality in men screened for abdominal aortic aneurysm.Design Prospective cohort study.Setting Highland and Western Isles (a large, sparsely populated area of Scotland).Participants 8146 men aged 65-74. Main outcome measuresMorbidity and mortality in relation to presence of abdominal aortic aneurysm and three categories of aortic diameter (≤24 mm, 25-29 mm, and ≥30 mm).Results When screened, 414 men (5.1%) had an aneurysm (diameter ≥30 mm), 669 (8.2%) an aortic diameter of 25-29 mm, and 7063 (86.7%) an aortic diameter of ≤24 mm. The cohort was followed up for a median of 7.4 (interquartile range 6.9-8.2) years. Mortality was significantly associated with aortic diameter: 512 (7.2%) men in the ≤24 mm group died compared with 69 (10.3%) in the 25-29 mm group and 73 (17.6%) in the ≥30 mm group. The mortality risk in men with an aneurysm or with an aorta measuring 25-29 mm was significantly higher than in men with an aorta of ≤24 mm. The increased mortality risk in the 25-29 mm group was reduced when taking confounders such as smoking and known heart disease into account. After adjustment, compared with men with an aortic diameter of ≤24 mm, the risk of hospital admission for cardiovascular disease and chronic obstructive pulmonary disease was significantly higher in men with aneurysm and those with aortas measuring 25-29 mm. Men with an aneurysm also had an increased risk of hospital admission for cerebrovascular disease, atherosclerosis, peripheral arterial disease, and respiratory disease. In men with aortas measuring 25-29 mm, the risk of hospital admission with abdominal aortic aneurysm was significantly higher than in men with an aorta of ≤24 mm (adjusted hazard ratio 6.7, 99% confidence interval 3.4 to 13.2) and this increased risk became apparent two years after screening. ConclusionsMen with abdominal aortic aneurysm and those with aortic diameters measuring 25-29 mm have an increased risk of mortality and subsequent hospital admissions compared with men with an aorta diameter of ≤24 mm. Consideration should be given to control of risk factors and to rescreening men with aortas measuring 25-29 mm at index scanning.

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Section: Discussionsupporting

confidence: 79%

Section: Discussioncontrasting

confidence: 44%

Section: Discussionmentioning

confidence: 66%

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Long term outcomes in men screened for abdominal aortic aneurysm: prospective cohort study

Duncan

Harrild

Iversen

et al. 2012

BMJ

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“…These results are based on analysis of change over two years and it is possible that lower educational groups are simply slower to take up new services and resources and that, over time, the socioeconomic differences will diminish. Several possible plausible barriers to take-up can, however, be identified including inadequate information about services, socioeconomic differences in the concepts of health and disagreement about the importance of the service, language differences and the costs of participation 15 – 19. The potential for health promotion activities to increase social inequalities in health has been noted20 – 22 and community development approaches to health promotion have been proposed as one way of building more appropriate interventions 23.…”

Section: Discussionmentioning

confidence: 99%

Tackling inequalities in health: evaluating the New Deal for Communities initiative

Stafford¹,

Nazroo

Popay

et al. 2008

Journal of Epidemiology & Community Health

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Evidence from two-year follow-up does not support an NDC effect, either overall or for particular population groups. Residents with lower education experienced the least favourable health profiles at baseline and the smallest improvements. Programme leaders should consider how to encourage participation among those with the lowest education. A shallower social gradient in participation in education and training in NDC areas and a lack of gradient in income, crime and environmental outcomes indicate that some aspects of the programme may be reaching all sections of the community.

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“…Several studies have shown that AAA screening programs in rural or underserved areas can be successful and cost-effective. 20,21 By preventing the rupture before it happens, any discussion about difference in mortality by surgeon specialization becomes moot.…”

Section: Discussionmentioning

confidence: 99%

The effect of surgeon specialization on outcomes after ruptured abdominal aortic aneurysm repair

Hawkins

Smith

Schaumeier

et al. 2014

Journal of Vascular Surgery

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Geography, private costs and uptake of screening for abdominal aortic aneurysm in a remote rural area

Cited by 5 publications

References 32 publications

Long term outcomes in men screened for abdominal aortic aneurysm: prospective cohort study

Long term outcomes in men screened for abdominal aortic aneurysm: prospective cohort study

Tackling inequalities in health: evaluating the New Deal for Communities initiative

The effect of surgeon specialization on outcomes after ruptured abdominal aortic aneurysm repair

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