title: Uptake of abdominal aortic aneurysm screening. A cohort study.
abstract: BACKGROUND
  Abdominal aortic aneurysms (AAA) are responsible for 1.4% of UK deaths. Deprivation is a risk factor for AAA. Screening reduces AAA related mortality and is cost effective if uptake remains high. The Highland aneurysm screening programme (HASP) began in 2001 offering screening to men in a sparsely populated area. The aim was to identify whether uptake varies with deprivation or rurality, in the context of an established programme.
  
  
  METHODS
  Retrospective interrogation of HASP records was performed on all men offered screening from 2001 until 2010. Deprivation and rurality status were derived from postcode of residence (SIMD'09 and URC'08) and the relationships with screening uptake were examined.
  
  
  RESULTS
  Mean uptake over the decade was 90.1%. There was a strong association between deprivation and uptake, which ranged from 79.5% in the most deprived population to 97.5% in the least deprived (p < 0.001). The odds of men who were least deprived attending was 10.6 times higher than those who were most deprived (p < 0.001). Higher uptake was observed in more rural areas (p = 0.02). When combined in a logistic regression model, only deprivation remained significant, indicating any apparent effect of rurality was explained by deprivation. No change was observed in the mean aortic diameter of 65-year-old men or the incidence of AAA.
  
  
  CONCLUSIONS
  HASP has a high uptake even in the most deprived and rural populations, demonstrating that programme design has overcome any potential rural disadvantage. A gradient of uptake associated with deprivation remains, although even the most deprived have an uptake of almost 80%.
authors.affiliation: Department of Surgery, Raigmore Hospital, NHS Highland, Inverness, Scotland, UK. natashaross@nhs.net
authors.forename: N P
authors.initials: NP
authors.lastname: Ross
authors.forename: N W
authors.initials: NW
authors.lastname: Scott
authors.forename: J L
authors.initials: JL
authors.lastname: Duncan
mesh_terms: D000367:Age Factors; D000368:Aged; D017544:Aortic Aneurysm, Abdominal / Q000175:diagnosis* / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D016015:Logistic Models; D008297:Male; D008403:Mass Screening / Q000379:methods*; D016017:Odds Ratio; D010342:Patient Acceptance of Health Care; D011237:Predictive Value of Tests; D012111:Residence Characteristics; D012189:Retrospective Studies; D012307:Risk Factors; D019035:Rural Health Services; D012606:Scotland / Q000453:epidemiology; D012737:Sex Factors; D012959:Socioeconomic Factors; D013997:Time Factors