title: Aneurysm global epidemiology study: public health measures can further reduce abdominal aortic aneurysm mortality.
abstract: BACKGROUND
  Contemporary data from Western populations suggest steep declines in abdominal aortic aneurysm (AAA) mortality; however, international trends are unclear. This study aimed to investigate global AAA mortality trends and to analyze any association with common cardiovascular risk factors.
  
  
  RESULTS
  AAA mortality (1994-2010) using International Classification of Diseases codes were extracted from the World Health Organization mortality database and age standardized. The World Health Organization InfoBase and International Mortality and Smoking Statistics provided risk factor data. Nineteen World Health Organization member states were included (Europe, 14; Australasia, 2; North America, 2; Asia, 1). Regression analysis of temporal trends in cardiovascular risk factors (1946-2010) was done independently for correlations to AAA mortality trends. Global AAA mortality trends show substantial heterogeneity, with the United States and United Kingdom recording the greatest national decline, whereas internationally, male individuals and those <75 years of age demonstrated the greatest reductions. AAA mortality has increased in Hungary, Romania, Austria, and Denmark; therefore, the mortality decline is not universal. A positive linear relationship exists between global trends in systolic blood pressure (P≤0.03), cholesterol (P≤0.03), and smoking prevalence (P≤0.02) in males and females. Body mass index demonstrated a negative linear association with AAA mortality (P≤0.007), whereas fasting blood glucose showed no association.
  
  
  CONCLUSIONS
  AAA mortality has not declined globally, and this study reveals that differences between nations can be explained by variations in traditional cardiovascular risk factors. Declines in smoking prevalence correlate most closely with declines in AAA mortality, and a novel obesity paradox has been identified that requires further investigation. Public health measures could therefore further reduce global AAA mortality, with greatest benefits in the younger age group.
authors.affiliation: Vascular Surgery Group, Department of Cardiovascular Sciences (D.S., P.S., N.D., M.B., R.S., E.C.) and Department of Health Sciences (J.T.), University of Leicester, Leicester, UK.
authors.forename: David
authors.initials: D
authors.lastname: Sidloff
authors.forename: Philip
authors.initials: P
authors.lastname: Stather
authors.forename: Nikesh
authors.initials: N
authors.lastname: Dattani
authors.forename: Matthew
authors.initials: M
authors.lastname: Bown
authors.forename: John
authors.initials: J
authors.lastname: Thompson
authors.forename: Robert
authors.initials: R
authors.lastname: Sayers
authors.forename: Edward
authors.initials: E
authors.lastname: Choke
mesh_terms: D000368:Aged; D017544:Aortic Aneurysm, Abdominal / Q000401:mortality*; D005260:Female; D014943:Global Health / Q000706:statistics & numerical data*; D006801:Humans; D006973:Hypertension / Q000401:mortality; D008297:Male; D008875:Middle Aged; D009026:Mortality / Q000639:trends; D015995:Prevalence; D011634:Public Health / Q000706:statistics & numerical data*; D012307:Risk Factors; D040242:Risk Reduction Behavior; D012907:Smoking / Q000401:mortality
keywords: aneurysm; aorta; epidemiology; mortality