Incidence and outcomes of ruptured abdominal aortic aneurysms in rural and urban Australia.
BACKGROUND
Rural and regional populations suffer higher rates of preventable disease and all-cause mortality than urban areas, with rural areas of the USA experiencing double the rate of ruptured abdominal aortic aneurysms (AAAs). We investigated the incidence and outcomes of ruptured AAAs in an Australian rural and regional setting, and compared these with those of an urban population.


METHODS
We undertook a retrospective analysis of all patients suffering AAA rupture in New South Wales (NSW) from 2009/2010 to 2010/2011. Variables included rates of rupture, mortality and intensive care admission. Urban and rural-regional areas were stratified according to NSW Health Local Health Districts, and comparisons between the two groups were performed.


RESULTS
Ruptured AAAs had an incidence of 4.1/100 000, with males twice as likely to suffer AAA rupture (P = 0.009), but females 88% more likely to die from rupture (P = 0.001). There was no significant difference between AAA rupture rates (5.0 versus 3.4 per 100 000; P = 0.054) nor case-fatality rates (41.22% versus 40.94%; P = 0.087) in rural-regional and urban populations. Patients in urban areas had a longer hospital stay (5 days versus 1 day, P = 0.001), were more likely to be admitted to intensive care unit (29.4% versus 19.9%, P = 0.001) and were less likely to be transferred to another hospital (19% versus 32%, P = 0.001).


CONCLUSIONS
AAA ruptures remain a significant public health burden. Rural and regional areas suffer disproportionately, which may be improved by implementation of AAA screening and funding for rural and regional hospitals to sustain adequate surgical and intensive care facilities.
University of Notre Dame, Sydney, New South Wales, Australia; St John of God Hospital, Ballarat, Victoria, Australia.
Timothy
T
Shiraev
Michael G
MG
Condous
D000368:Aged; D000369:Aged, 80 and over; D017544:Aortic Aneurysm, Abdominal / Q000453:epidemiology* / Q000401:mortality / Q000601:surgery; D001019:Aortic Rupture / Q000453:epidemiology* / Q000401:mortality / Q000601:surgery; D005260:Female; D006801:Humans; D015994:Incidence; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009517:New South Wales / Q000453:epidemiology; D012189:Retrospective Studies; D012424:Rural Population / Q000706:statistics & numerical data; D016896:Treatment Outcome; D014505:Urban Population / Q000706:statistics & numerical data
AAA rupture; rural