The population prevalence of undetected abdominal aortic aneurysm in New Zealand Māori

Sandiford, Peter; Grey, Corina; Salvetto, Micol; Hill, Andrew; Malloy, Timothy F.; Cranefield, D.; Bramley, Dale

doi:10.1016/j.jvs.2019.07.055

Cited by 9 publications

(11 citation statements)

References 21 publications

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“…There are examples of health service providers in NZ that have achieved equal or greater screening coverage for Māori, demonstrating that, with good design and engagement with Māori, equal coverage is achievable. 28 42 Our scenario analysis of increased invitation costs to improve Māori screening coverage remained cost-effective. In the model we account for outflow, where a proportion of the population will reach 15 years post cessation after initially being eligible.…”

Section: Discussionmentioning

confidence: 92%

“…A well-designed programme that prioritises Māori engagement and outcomes can achieve high screening coverage for Māori without any additional costs. 28 A scenario analysis of increased costs to address inequities in screening coverage due to a poorly designed programme was also undertaken by doubling invitation costs for the entire screening cohort.…”

Section: Model Inputsmentioning

confidence: 99%

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Impact of low-dose CT screening for lung cancer on ethnic health inequities in New Zealand: a cost-effectiveness analysis

McLeod

Sandiford

Kvizhinadze³

et al. 2020

BMJ Open

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ObjectiveThere are large inequities in the lung cancer burden for the Indigenous Māori population of New Zealand. We model the potential lifetime health gains, equity impacts and cost-effectiveness of a national low-dose CT (LDCT) screening programme for lung cancer in smokers aged 55–74 years with a 30 pack-year history, and for formers smokers who have quit within the last 15 years.DesignA Markov macrosimulation model estimated: health benefits (health-adjusted life-years (HALYs)), costs and cost-effectiveness of biennial LDCT screening. Input parameters came from literature and NZ-linked health datasets.SettingNew Zealand.ParticipantsPopulation aged 55–74 years in 2011.InterventionsBiennial LDCT screening for lung cancer compared with usual care.Outcome measuresIncremental cost-effectiveness ratios were calculated using the average difference in costs and HALYs between the screened and the unscreened populations. Equity analyses included substituting non-Māori values for Māori values of background morbidity, mortality and stage-specific survival. Changes in inequities in lung cancer survival and ‘health-adjusted life expectancy’ (HALE) were measured.ResultsLDCT screening in NZ is likely to be cost-effective for the total population: NZ$34 400 per HALY gained (95% uncertainty interval NZ$27 500 to NZ$42 900) and for Māori separately (using a threshold of gross domestic product per capita NZ$45 000). Health gains per capita for Māori females were twice that for non-Māori females and 25% greater for Māori males compared with non-Māori males. LDCT screening will narrow absolute inequities in HALE and lung cancer mortality for Māori, but will slightly increase relative inequities in mortality from lung cancer (compared with non-Māori) due to differential stage-specific survival.ConclusionA national biennial LDCT lung cancer screening programme in New Zealand is likely to be cost-effective, will improve total population health and reduce health inequities for Māori. Attention must be paid to addressing ethnic inequities in stage-specific lung cancer survival.

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Section: Discussionmentioning

confidence: 92%

Section: Model Inputsmentioning

confidence: 99%

Impact of low-dose CT screening for lung cancer on ethnic health inequities in New Zealand: a cost-effectiveness analysis

McLeod

Sandiford

Kvizhinadze³

et al. 2020

BMJ Open

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“…Black Americans have also been reported to more frequently develop renal failure following AAA repair than other races (49), whereas Asian people have been reported to have the highest rate of post AAA repair myocardial infarction (49). A screening study of New Zealand Maori men reported that the prevalence of AAA was higher than in Caucasian men (184). Among patients admitted to New Zealand hospitals with a diagnosis of AAA (1996 -2007), Maori patients were found to be younger, with a higher mortality rate than European and Asian men, whereas Asian men and women had a significantly lower mortality rate than the European patients (185).…”

Section: Aortic Aneurysm and The Associated Risk Factorsmentioning

confidence: 99%

Pathogenic mechanisms and the potential of drug therapies for aortic aneurysm

Liu

Granville

Golledge

et al. 2020

American Journal of Physiology-Heart and Circulatory Physiology

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Aortic aneurysm is a permanent focal dilation of the aorta. It is usually an asymptomatic disease but can lead to sudden death due to aortic rupture. Aortic aneurysm-related mortalities are estimated at ∼200,000 deaths per year worldwide. Because no pharmacological treatment has been found to be effective so far, surgical repair remains the only treatment for aortic aneurysm. Aortic aneurysm results from changes in the aortic wall structure due to loss of smooth muscle cells and degradation of the extracellular matrix and can form in different regions of the aorta. Research over the past decade has identified novel contributors to aneurysm formation and progression. The present review provides an overview of cellular and noncellular factors as well as enzymes that process extracellular matrix and regulate cellular functions (e.g., matrix metalloproteinases, granzymes, and cathepsins) in the context of aneurysm pathogenesis. An update of clinical trials focusing on therapeutic strategies to slow abdominal aortic aneurysm growth and efforts underway to develop effective pharmacological treatments is also provided.

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“…Abdominal aortic aneurysm (AAA) has a prevalence in the general population of approximately 4.8%. 1 Infrarenal AAA is the most prevalent type, with the risk of rupture related to the Correspondence to email gerry.hill@otago.ac.nz doi: 10.1002/ajum.12319 absolute diameter. AAA occurs secondary to weakening of the aortic arterial wall, which increases with age, progressing to further dilatation and decreased wall thickness, resulting in increased wall tension and potential rupture and lifethreatening haemorrhage.…”

Section: Introductionmentioning

confidence: 99%

“…Abdominal aortic aneurysm (AAA) has a prevalence in the general population of approximately 4.8% 1 . Infrarenal AAA is the most prevalent type, with the risk of rupture related to the absolute diameter.…”

Section: Introductionmentioning

confidence: 99%

The correlation between different ultrasound planes and computed tomography measures of abdominal aortic aneurysms

Hill

Holloway

Lim

et al. 2022

Australas J Ultrason Med

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Introduction Ultrasound measurements of the aorta are typically taken in the axial plane, with the transducer perpendicular to the aorta, and diameter measurements are obtained by placing the callipers from the anterior to the posterior wall and the transverse right to the left side of the aorta. While the ‘conventional’ anteroposterior walls in both sagittal and transverse plains may be suitable for aneurysms with less complicated geometry, there is controversy regarding the suitability of this approach for complicated, particularly tortuous aneurysms, as they may offer a more challenging situation. Previous work undertaken within our research group found that when training inexperienced users of ultrasound, they demonstrated more optimal calliper placement to the abdominal aorta when approached from a decubitus window to obtain a coronal image compared to the traditional ultrasound approach. Purpose To observe the level of agreement in real‐world reporting between computed tomography (CT) and ultrasound measurements in three standard planes; transverse AP, sagittal AP and coronal (left to right) infra‐renal abdominal aortic aneurysm (AAA) diameter. Methodology This is a retrospective review of the Otago Vascular Diagnostics database for AAA, where ultrasound and CT diameter data, available within 90 days of each other, were compared. In addition to patient demographics, the infrarenal aorta ultrasound diameter measurements in transverse AP and sagittal AP, along with a coronal decubitus image of the aorta was collected. No transverse measurement was performed from the left to the right of the aorta. Results Three hundred twenty‐five participants (238 males, mean age 76.4 ± 7.5) were included. Mean ultrasound outer to the outer wall, transverse AP and sagittal AP diameters were 48.7 ± 10.5 mm and 48.9 ± 9.9 mm, respectively. The coronal diameter measurement of the aorta from left to right was 53.9 ± 12.8 mm in the left decubitus window. The mean ultrasound max was 54.3 ± 12.6 mm. The mean CT diameter measurement was 55.6 ± 12.7 mm. Correlation between the CT max and ultrasound max was r2 = 0.90, and CT with the coronal measurement r2 = 0.90, CT and AP transverse was r2=0.80, and CT with AP sagittal measurement was r2 = 0.77. Conclusion The decubitus ultrasound window of the abdominal aorta, with measurement of the coronal plane, is highly correlated and in agreement with CT scanning. This window may offer an alternative approach to measuring the infrarenal abdominal aortic aneurysm and should be considered when performing surveillance of all infra‐renal AAA.

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The population prevalence of undetected abdominal aortic aneurysm in New Zealand Māori

Cited by 9 publications

References 21 publications

Impact of low-dose CT screening for lung cancer on ethnic health inequities in New Zealand: a cost-effectiveness analysis

Impact of low-dose CT screening for lung cancer on ethnic health inequities in New Zealand: a cost-effectiveness analysis

Pathogenic mechanisms and the potential of drug therapies for aortic aneurysm

The correlation between different ultrasound planes and computed tomography measures of abdominal aortic aneurysms

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