Population-Based Study of Incidence of Acute Abdominal Aortic Aneurysms With Projected Impact of Screening Strategy.
BACKGROUND
Current abdominal aortic aneurysm (AAA) screening in men age 65 might have limited impact on overall AAA death rates if incidence is moving to older ages. Up-to-date population-based studies of age-specific incidence, risk factors, and outcome of acute AAA are needed to inform screening policy.


RESULTS
In a prospective, population-based study (Oxfordshire, UK, 2002-2014), the incidence and outcome of acute AAA events were determined. Based on population projections and current incidence trends, the impact of screening strategies in the UK was estimated. Over the 12-year period, 103 incident acute AAA events occurred in the study population of 92 728. Incidence/100 000/year was 55 in men ages 65 to 74 years, but increased to 112 at 75 to 85 and 298 at ≥85, with 66.0% of all events occurring at age ≥75 years. Incidence at ages 65 to 74 was highest in male smokers (274), with 96.4% of events in men <75 years occurring in ever-smokers. Extrapolating rates to the UK population, using trial evidence of screening efficacy, the current UK screening program would prevent 5.6% of aneurysm-related deaths (315 200 scans/year: 1426/death prevented, 121/year-of-life saved). Screening only male smokers age 65 and then all men at age 75 would prevent 21.1% of deaths (247 900 scans/year; 297/death prevented, 34/year-of-life saved). By 2030, 91.0% of deaths will occur at age ≥75, 61.6% at ≥85, and 28.6% in women.


CONCLUSIONS
Given that two thirds of acute AAA occurred at ≥75 years of age, screening older age groups should be considered. Screening nonsmokers at age 65 is likely to have very little impact on AAA event rates.
Stroke Prevention Research Unit, Nuffield Department of Clinical Neurosciences, University of Oxford, United Kingdom (D.J.H., A.B., J.F.F., L.E.S., P.M.R.).
Dominic P J
DP
Howard
Stroke Prevention Research Unit, Nuffield Department of Clinical Neurosciences, University of Oxford, United Kingdom (D.J.H., A.B., J.F.F., L.E.S., P.M.R.) Center for Cardiovascular Sciences, University of Birmingham, Birmingham, United Kingdom (A.B.).
Amitava
A
Banerjee
Stroke Prevention Research Unit, Nuffield Department of Clinical Neurosciences, University of Oxford, United Kingdom (D.J.H., A.B., J.F.F., L.E.S., P.M.R.) Department of Vascular Surgery, Oxford University Hospitals NHS Trust, Oxford, United Kingdom (J.F.F., A.H.).
Jack F
JF
Fairhead
Department of Vascular Surgery, Oxford University Hospitals NHS Trust, Oxford, United Kingdom (J.F.F., A.H.).
Ashok
A
Handa
Stroke Prevention Research Unit, Nuffield Department of Clinical Neurosciences, University of Oxford, United Kingdom (D.J.H., A.B., J.F.F., L.E.S., P.M.R.).
Louise E
LE
Silver
Stroke Prevention Research Unit, Nuffield Department of Clinical Neurosciences, University of Oxford, United Kingdom (D.J.H., A.B., J.F.F., L.E.S., P.M.R.).
Peter M
PM
Rothwell
D000208:Acute Disease; D017677:Age Distribution; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D017544:Aortic Aneurysm, Abdominal / Q000175:diagnosis* / Q000453:epidemiology* / Q000517:prevention & control; D004739:England / Q000453:epidemiology; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008403:Mass Screening / Q000379:methods*; D008875:Middle Aged; D018579:Patient Selection; D011237:Predictive Value of Tests; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D017678:Sex Distribution; D012737:Sex Factors; D012907:Smoking / Q000009:adverse effects / Q000453:epidemiology; D013997:Time Factors
abdominal aortic aneurysms; population projection analysis; risk factor profiling; screening and prevention