title: National trends in incidence and outcomes of abdominal aortic aneurysm among elderly type 2 diabetic and non-diabetic patients in Spain (2003-2012).
abstract: BACKGROUND
  This study aims to describe trends in the rate of abdominal aortic aneurysm (AAA) and use of open surgery repair (OSR) and endovascular aneurysm repair (EVAR) in elderly patients with and without type 2 diabetes in Spain, 2003-2012.
  
  
  METHODS
  We select all patients with a discharge of AAA using national hospital discharge data. Discharges were grouped by diabetes status: type 2 diabetes and no diabetes. In both groups OSR and EVAR were identified. The incidence of discharges attributed to AAA were calculated overall and stratified by diabetes status and year. We calculated length of stay (LOHS) and in-hospital mortality (IHM). Use of OSR and EVAR were calculated stratified by diabetes status. Multivariate analysis was adjusted by age, sex, year, smoking habit and comorbidity.
  
  
  RESULTS
  From 2003 to 2012, 115,020 discharges with AAA were identified. The mean age was 74.91 years and 16.7% suffered type 2 diabetes. Rates of discharges due to AAA increased significantly in diabetic patients (50.09 in 2003 to 78.23 cases per 100,000 in 2012) and non diabetic subjects (69.24 to 78.66). The incidences were higher among those without than those with diabetes in all the years studied. The proportion of patients that underwent EVAR increased for both groups of patients and the open repair decreased. After multivariate analysis we found that LOHS and IHM have improved over the study period and diabetic patients had lower IHM than those without diabetes (OR 0.81; 95%CI 0.76-0.85).
  
  
  CONCLUSIONS
  Incidence rates were higher in non-diabetic patients. For diabetic and non diabetic patients the use of EVAR has increased and open repair seems to be decreasing. IHM and LOHS have improved from 2003 to 2012. Patients with diabetes had significantly lower mortality.
authors.affiliation: Preventive Medicine and Public Health Teaching and Research Unit, Health Sciences Faculty, Rey Juan Carlos University, Avda. de Atenas s/n, 28922, Alcorcon, Comunidad deMadrid, Spain. ana.lopez@urjc.es.
authors.forename: Ana
authors.initials: A
authors.lastname: Lopez-de-Andrés
authors.affiliation: Preventive Medicine and Public Health Teaching and Research Unit, Health Sciences Faculty, Rey Juan Carlos University, Avda. de Atenas s/n, 28922, Alcorcon, Comunidad deMadrid, Spain. isabel.jimenez@urjc.es.
authors.forename: Isabel
authors.initials: I
authors.lastname: Jiménez-Trujillo
authors.affiliation: Preventive Medicine and Public Health Teaching and Research Unit, Health Sciences Faculty, Rey Juan Carlos University, Avda. de Atenas s/n, 28922, Alcorcon, Comunidad deMadrid, Spain. rodrigo.jimenez@urjc.es.
authors.forename: Rodrigo
authors.initials: R
authors.lastname: Jiménez-García
authors.affiliation: Preventive Medicine and Public Health Teaching and Research Unit, Health Sciences Faculty, Rey Juan Carlos University, Avda. de Atenas s/n, 28922, Alcorcon, Comunidad deMadrid, Spain. valentin.hernandez@urjc.es.
authors.forename: Valentín
authors.initials: V
authors.lastname: Hernández-Barrera
authors.affiliation: Medicine Department, Hospital Gregorio Marañon, Comunidad de Madrid, Spain. josemaria.demiguel@salud.madrid.org.
authors.forename: José M
authors.initials: JM
authors.lastname: de Miguel-Yanes
authors.affiliation: Medicine Department, Hospital Clínico San Carlos, Madrid, Comunidad de Madrid, Spain. manuel.mendez@salud.madrid.org.
authors.forename: Manuel
authors.initials: M
authors.lastname: Méndez-Bailón
authors.affiliation: Health Security Agency, Ministry of Health, Madrid, Comunidad de Madrid, Spain. nperezf@msssi.es.
authors.forename: Napoleón
authors.initials: N
authors.lastname: Perez-Farinos
authors.affiliation: Dirección Técnica de Docencia e Investigación, Gerencia Atención Primaria, Madrid, Comunidad de Madrid, Spain. miguel.salinero@salud.madrid.org.
authors.forename: Miguel Ángel
authors.initials: MÁ
authors.lastname: Salinero-Fort
authors.affiliation: Preventive Medicine and Public Health Teaching and Research Unit, Health Sciences Faculty, Rey Juan Carlos University, Avda. de Atenas s/n, 28922, Alcorcon, Comunidad deMadrid, Spain. pilar.carrasco@urjc.es.
authors.forename: Pilar
authors.initials: P
authors.lastname: Carrasco-Garrido
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D017544:Aortic Aneurysm, Abdominal / Q000175:diagnosis* / Q000453:epidemiology* / Q000628:therapy; D003924:Diabetes Mellitus, Type 2 / Q000175:diagnosis* / Q000453:epidemiology* / Q000628:therapy; D005260:Female; D005500:Follow-Up Studies; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D015994:Incidence; D008297:Male; D012189:Retrospective Studies; D013030:Spain / Q000453:epidemiology; D016896:Treatment Outcome