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Abdominal Aortic Aneurysm: Experience from a Screening Study in Northern Sweden
Uppsala University, Medicinska vetenskapsområdet, Faculty of Medicine, Department of Surgical Sciences.
2004 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Abdominal aortic aneurysm (AAA) is a common problem with life-threatening consequences and was suspected to be a serious health problem in Norsjö, a municipality in northern Sweden. A screening study was undertaken to investigate the prevalence, risk factors associated with AAA and the effect of screening on quality of life (QoL). All men and women, aged 65-75 years, were invited to an ultrasonography (US) examination, 91% attended and 92 subjects were also evaluated with computed tomography (CT).

Depending on diagnostic criteria, the AAA prevalence was 3.6-16.9% in men and 0.8-9.4% in women. Seventy-five percent of the differences between US- and CT anteroposterior measurements were less than 5 mm. A decrease in mental health was observed among AAA patients with low baseline SF-36 scale scores. Elevated cholesterol at age 60 years were associated with screening detected AAA after 12 years of follow-up. Smoking, atherosclerosis and having a first degree relative with AAA were associated with AAA at screening. Compared to blood samples obtained 12 years prior to screening an elevation of hsCRP over time was observed among AAA patients.

Based on a systematic review of the literature, different screening strategies were analysed in a Markov cohort model. The cost per life year gained ranged from $8 309 to $14 084 and was estimated to $10 474 when 65 year old men were screened once.

Conclusions: The highest prevalence of AAA ever reported, in a population-based screening program, was found in Norsjö. The risk of having an AAA at screening showed a strong but complex association with atherosclerosis and its risk factors, genetic and inflammatory mechanisms may also be important. Screening 65-year-old men for AAA may be cost-effective, but QoL aspects on the cost-effectiveness of AAA screening merits further investigation.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis , 2004. , p. 96
Series
Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 0282-7476 ; 1364
Keywords [en]
Surgery, abdominal aortic aneurysm, definition, prevalence, ultrasonography, computed tomography, variability, quality of life, SF-36, risk factor, cholesterol, smoking, CRP, heredity, atherosclerosis, screening, cost-effectiveness, cost-utility
Keywords [sv]
Kirurgi
National Category
Surgery
Identifiers
URN: urn:nbn:se:uu:diva-4459ISBN: 91-554-6008-9 (print)OAI: oai:DiVA.org:uu-4459DiVA, id: diva2:164896
Public defence
2004-09-24, Auditorium Minus, Museum Gustavianum, Uppsala, 13:15
Opponent
Supervisors
Available from: 2004-09-01 Created: 2004-09-01Bibliographically approved
List of papers
1. The influence of diagnostic criteria on the prevalence of abdominal aortic aneurysm
Open this publication in new window or tab >>The influence of diagnostic criteria on the prevalence of abdominal aortic aneurysm
Show others...
2001 In: J Vasc Surg, no 34, p. 229-235Article in journal (Refereed) Published
Identifiers
urn:nbn:se:uu:diva-91969 (URN)
Available from: 2004-09-01 Created: 2004-09-01Bibliographically approved
2. Intertechnique differences in measuring the dimensions of the abdominal aorta: comparison of ultrasonography and computed tomography
Open this publication in new window or tab >>Intertechnique differences in measuring the dimensions of the abdominal aorta: comparison of ultrasonography and computed tomography
2002 In: Eur J Vasc Endovasc Surg, no 24, p. 428-434Article in journal (Refereed) Published
Identifiers
urn:nbn:se:uu:diva-91970 (URN)
Available from: 2004-09-01 Created: 2004-09-01Bibliographically approved
3. Low quality of life prior to screening for abdominal aortic aneurysm: a possible risk factor for negative mental effects
Open this publication in new window or tab >>Low quality of life prior to screening for abdominal aortic aneurysm: a possible risk factor for negative mental effects
Show others...
2004 (English)In: Annals of Vascular Surgery, ISSN 0890-5096, E-ISSN 1615-5947, Vol. 18, no 3, p. 287-293Article in journal (Refereed) Published
Abstract [en]

The objective of this study was to evaluate the effect on quality of life (QOL) of screening for abdominal aortic aneurysm (AAA) in a population-based AAA screening program. Twenty-four patients with screening-detected AAA and 45 controls with normal aortic diameter were studied in a prospective, controlled, population-based study. Prior to and 12 months after the ultrasonography examination, all participants completed Short-Form 36 and at 12 months, 10 AAA-specific questions were added. Comparisons were made between the two groups (AAA patients and controls), within each group, and between the groups and norms for the general Swedish population in the same age interval. Our results showed that screening for AAA results in impairment of QOL among those who have the disease and who suffered a low QOL prior to screening. Among those who had an age-adjusted normal QOL prior to screening and who were found to have the disease, and among those who were found to have normal aortas, no negative effect on QOL was observed. Thus, low QOL before screening is a possible risk factor for negative mental effects of diagnosing an AAA by screening.

Keywords
Activities of Daily Living, Aged, Aortic Aneurysm; Abdominal/*diagnosis/epidemiology/*psychology, Comparative Study, Female, Follow-Up Studies, Humans, Male, Mass Screening, Prospective Studies, Psychomotor Performance, Quality of Life, Research Support; Non-U.S. Gov't, Risk Factors, Sickness Impact Profile, Sweden
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-91971 (URN)10.1007/s10016-004-0021-x (DOI)15354629 (PubMedID)
Available from: 2004-09-01 Created: 2004-09-01 Last updated: 2017-12-14Bibliographically approved
4. Factors associated with the development of abdominal aortic aneurysm. A study based on historical- and cross-sectional screening data
Open this publication in new window or tab >>Factors associated with the development of abdominal aortic aneurysm. A study based on historical- and cross-sectional screening data
Show others...
(English)Article in journal (Refereed) Submitted
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-91972 (URN)
Available from: 2004-09-01 Created: 2004-09-01 Last updated: 2013-08-14Bibliographically approved
5. Screening for abdominal aortic aneurysm in men. An economic evaluation based on a systematic review of the literature
Open this publication in new window or tab >>Screening for abdominal aortic aneurysm in men. An economic evaluation based on a systematic review of the literature
Article in journal (Refereed) Submitted
Identifiers
urn:nbn:se:uu:diva-91973 (URN)
Available from: 2004-09-01 Created: 2004-09-01Bibliographically approved

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