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Wu VS, Caputo FJ, Quatromoni JG, Kirksey L, Lyden SP, Rowse JW. Association between socioeconomic deprivation and presentation with a ruptured abdominal aortic aneurysm. J Vasc Surg 2024; 79:44-54. [PMID: 37657685 DOI: 10.1016/j.jvs.2023.08.127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 08/14/2023] [Accepted: 08/26/2023] [Indexed: 09/03/2023]
Abstract
OBJECTIVE Given the ongoing nature of research in the social determinants space and urges to improve United States Preventive Services Task Force screening efforts for abdominal aortic aneurysms (AAAs), this project aims to characterize the association between the level of socioeconomic deprivation, rurality, and ruptured AAA (rAAA) presentation across the United States. METHODS We queried the Vascular Quality Initiative registry (2010-2019) for patients with AAAs. The area deprivation index (ADI) is an index from 1 to 100 used to capture socioeconomic status. ADI was grouped into quintiles, with the most deprived regions being quintile 5 and having the highest ADI index. Multivariable logistic regression assessed the association between ADI, rurality, and rAAA presentation overall and before age 65. RESULTS Of the 82,909 patients included, 11,458 patients (14%) resided in the most socioeconomically deprived regions, and 18,083 patients (22%) lived in rural regions. Overall, 6831 patients (8.2%) experienced an rAAA, with 4696 patients (69%) residing in the three most deprived quintiles. Most patients underwent endovascular repair (n = 67,933; 82%), followed by open repair (n = 14,976; 18%). On multivariable analysis, residence in the most socioeconomically deprived region was associated with a near 1.5-fold increased odds of presenting with an rAAA compared with a residence in the least deprived regions (odds ratio [OR], 1.46; 95% confidence interval [CI], 1.31-1.63; P < .001), whereas urban residence was associated with a decreased odds to present with an rAAA compared with rural residence (OR, 0.84; 95% CI, 0.79-0.89; P < .001). When stratifying the study population by the United States Preventive Services Task Force recommended age for AAA screening (65 years old), 14,147 patients (17%) were under 65. Of those under 65, 1381 patients (9.8%) experienced a rAAA, and 9955 patients (71%) resided in the three most deprived quintiles. Residence in the most socioeconomically deprived region was associated with an increased odds of presenting with an rAAA compared with residence in the least deprived region (OR, 1.31; 95% CI, 1.01-1.69; P = .042). However, there were no significant associations between rural residence and increased rAAA presentation among individuals under 65 (OR, 1.07; 95% CI, 0.93-1.23; P = .36). CONCLUSIONS Among all patients in this study, patients residing in highly socioeconomically deprived or rural regions were more likely to present with an rAAA, but among those under 65, only residence in a socioeconomically deprived area was associated with increased odds of rAAA presentation. Understanding the effects of socioeconomic deprivation on rAAA presentation can identify at-risk populations for early AAA screening before rupture.
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Affiliation(s)
- Victoria S Wu
- Case Western Reserve University School of Medicine, Cleveland, OH.
| | - Francis J Caputo
- Department of Vascular Surgery, Cleveland Clinic Foundation, Cleveland, OH
| | - Jon G Quatromoni
- Department of Vascular Surgery, Cleveland Clinic Foundation, Cleveland, OH
| | - Lee Kirksey
- Department of Vascular Surgery, Cleveland Clinic Foundation, Cleveland, OH
| | - Sean P Lyden
- Department of Vascular Surgery, Cleveland Clinic Foundation, Cleveland, OH
| | - Jarrad W Rowse
- Department of Vascular Surgery, Cleveland Clinic Foundation, Cleveland, OH
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2
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Mota L, Marcaccio CL, Patel PB, Soden PA, Moreira CC, Stangenberg L, Hughes K, Schermerhorn ML. The impact of neighborhood social disadvantage on abdominal aortic aneurysm severity and management. J Vasc Surg 2023; 77:1077-1086.e2. [PMID: 36347436 PMCID: PMC10038823 DOI: 10.1016/j.jvs.2022.10.048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 09/22/2022] [Accepted: 10/25/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Recent studies have highlighted socioeconomic disparities in the severity and management of abdominal aortic aneurysm (AAA) disease. However, these studies focus on individual measures of social disadvantage such as income and insurance status. The area deprivation index (ADI), a validated measure of neighborhood deprivation, provides a more comprehensive assessment of social disadvantage. Therefore, we examined the impact of ADI on AAA severity and its management. METHODS We identified all patients who underwent endovascular or open repair of an AAA in the Vascular Quality Initiative registry between 2003 and 2020. An ADI score of 1 to 100 was assigned to each patient based on their residential zip code, with higher ADI scores corresponding with increasing deprivation. Patients were categorized by ADI quintiles. Outcomes of interest included rates of ruptured AAA (rAAA) repair versus an intact AAA repair and rates of endovascular repair (EVAR) versus the open approach. Logistic regression was used to evaluate for an independent association between ADI quintile and these outcomes. RESULTS Among 55,931 patients who underwent AAA repair, 6649 (12%) were in the lowest ADI quintile, 11,692 (21%) in the second, 15,958 (29%) in the third, 15,035 (27%) in the fourth, and 6597 (12%) in the highest ADI quintile. Patients in the two highest ADI quintiles had a higher proportion of rAAA repair (vs intact repair) compared with those in the lowest ADI quintile (8.8% and 9.1% vs 6.2%; P < .001). They were also less likely to undergo EVAR (vs open approach) when compared with the lowest ADI quintile (81% and 81% vs 88%; P < .001). There was an overall trend toward increasing rAAA and decreasing EVAR rates with increasing ADI quintiles (P < .001). In adjusted analyses, when compared with patients in the lowest ADI quintile, patients in the highest ADI quintile had higher odds of rAAA repair (odds ratio, 1.4; 95% confidence interval, 1.2-1.8; P < .001) and lower odds of undergoing EVAR (odds ratio, 0.54; 95% confidence interval, 0.45-0.65; P < .001). CONCLUSIONS Among patients who underwent AAA repair in the Vascular Quality Initiative, those with higher neighborhood deprivation had significantly higher rates of rAAA repair (vs intact repair) and lower rates of EVAR (vs open approach). Further work is needed to better understand neighborhood factors that are contributing to these disparities to identify community-level targets for improvement.
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Affiliation(s)
- Lucas Mota
- Division of Vascular and Endovascular Surgery, Beth Israel Deaconess Medical Center, Boston, MA
| | - Christina L Marcaccio
- Division of Vascular and Endovascular Surgery, Beth Israel Deaconess Medical Center, Boston, MA
| | - Priya B Patel
- Division of Vascular and Endovascular Surgery, Beth Israel Deaconess Medical Center, Boston, MA
| | - Peter A Soden
- Division of Vascular Surgery, Department of Surgery, Alpert Medical School of Brown University, Rhode Island Hospital, Providence, RI
| | - Carla C Moreira
- Division of Vascular Surgery, Department of Surgery, Alpert Medical School of Brown University, Rhode Island Hospital, Providence, RI
| | - Lars Stangenberg
- Division of Vascular and Endovascular Surgery, Beth Israel Deaconess Medical Center, Boston, MA
| | - Kakra Hughes
- Division of Vascular Surgery, Department of Surgery, Howard University College of Medicine, Washington, DC
| | - Marc L Schermerhorn
- Division of Vascular and Endovascular Surgery, Beth Israel Deaconess Medical Center, Boston, MA.
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Gudmundsdottir KK, Bonander C, Hygrell T, Svennberg E, Frykman V, Strömberg U, Engdahl J. Factors predicting participation and potential yield of screening-detected disease among non-participants in a Swedish population-based atrial fibrillation screening study. Prev Med 2022; 164:107284. [PMID: 36183797 DOI: 10.1016/j.ypmed.2022.107284] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 09/18/2022] [Accepted: 09/24/2022] [Indexed: 11/18/2022]
Abstract
BACKGROUND The success of any screening program is dependent on participation. The characteristics of participants vs. non-participants have been studied and non-participants usually have a higher risk of disease. The potential yield of screening-detected disease in non-participants could be of interest to several screening programs. AIMS This is a sub-study to STROKESTOP II, a Swedish atrial fibrillation screening study. The aim was to study factors predicting participation and to estimate the potential yield of screening-detected disease in non-participants. METHODS Individual, anonymized data for participants and non-participants with respect to socioeconomic factors, medical history and drugs dispensed were obtained from Swedish registries. A random forest model was trained to predict propensity scores for participation. The propensity scores were used to estimate potential screening-detected disease among non-participants. RESULTS Non-participants (n = 7086) had lower income, were more likely to have been hospitalized and had higher CHA2DS2-VASc scores compared to participants (n = 6868). The strongest factor predicting non-attendance was low income. The weighted estimates suggested that the yield of new atrial fibrillation was 2.4% in non-participants compared to 2.3% in the participants, which was not significant. CONCLUSIONS Non-participants had higher CHA2DS2-VASc scores, indicating a higher stroke-risk and presumable benefit from attending screening, although estimated new atrial fibrillation detected was not significantly more common when compared to participants. Low income was the strongest factor for predicting non-attendance and should be a focus area when planning future screening scenarios.
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Affiliation(s)
| | - Carl Bonander
- School of Public Health & Community Medicine, Sahlgrenska Academy at University of Gothenburg, Sweden
| | - Tove Hygrell
- Karolinska Institute, Department of Clinical Sciences, Danderyd University Hospital, Stockholm, Sweden
| | - Emma Svennberg
- Karolinska Institute, Department of medicine, Huddinge, Karolinska University Hospital, Stockholm, Sweden
| | - Viveka Frykman
- Karolinska Institute, Department of Clinical Sciences, Danderyd University Hospital, Stockholm, Sweden
| | - Ulf Strömberg
- School of Public Health & Community Medicine, Sahlgrenska Academy at University of Gothenburg, Sweden; Department of Research and Development, Region Halland, Halmstad, Sweden
| | - Johan Engdahl
- Karolinska Institute, Department of Clinical Sciences, Danderyd University Hospital, Stockholm, Sweden
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Jones E, Poyade M, Varsou O. Developing and evaluating a prototype public health mobile app on the UK NHS Abdominal Aortic Aneurysm Screening Programme. J Vis Commun Med 2022; 45:160-168. [DOI: 10.1080/17453054.2022.2037409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Ella Jones
- University of Glasgow, Glasgow, UK
- Glasgow School of Art, Glasgow, UK
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Robb KA. The integrated screening action model (I-SAM): A theory-based approach to inform intervention development. Prev Med Rep 2021; 23:101427. [PMID: 34189020 PMCID: PMC8220376 DOI: 10.1016/j.pmedr.2021.101427] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 05/13/2021] [Accepted: 05/25/2021] [Indexed: 12/12/2022] Open
Abstract
Screening can reduce deaths if the people invited participate. However, good uptake is hard to achieve, and our current approaches are failing to engage the most vulnerable. A coherent model of screening behaviour to guide our understanding and intervention development is yet to be established. The present aim was to propose an Integrated Screening Action Model (I-SAM) to improve screening access. The I-SAM synthesises existing models of health behaviour and empirical evidence. The I-SAM was developed following: i) an appraisal of the predominant models used within the screening literature; ii) the integration of the latest knowledge on behaviour change; with iii) the empirical literature, to inform the development of a theory-based approach to intervention development. There are three key aspects to the I-SAM: i) a sequence of stages that people pass through in engaging in screening behaviour (based on the Precaution Adoption Process Model); ii) screening behaviour is shaped by the interaction between participant and environmental influences (drawing from the Access Framework); and iii) targets for intervention should focus on the sources of behaviour - 'capability', 'opportunity', and 'motivation' (based on the COM-B Model). The I-SAM proposes an integrated model to support our understanding of screening behaviour and to identify targets for intervention. It will be an iterative process to test and refine the I-SAM and establish its value in supporting effective interventions to improve screening for all.
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Affiliation(s)
- Kathryn A. Robb
- Institute of Health and Wellbeing, University of Glasgow, Glasgow G12 0XH, United Kingdom
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6
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Parsons C, Khan KA, Pink J, Verran A, Griffiths F, Hutchinson CE, Petrou S. Preferences for portable ultrasound devices: a discrete choice experiment among abdominal aortic aneurysm surveillance patients and general ultrasound patients in England. BMJ Open 2018; 8:e025428. [PMID: 30573491 PMCID: PMC6303656 DOI: 10.1136/bmjopen-2018-025428] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
OBJECTIVE To undertake an assessment of preferences as to how, where and by whom ultrasounds (US) should be performed in: (1) patients undergoing surveillance of abdominal aortic aneurysm (AAA) size (AAA group); and (2) patients being scanned for general abdominal conditions (general group). DESIGN A discrete choice experiment (DCE) questionnaire was administered to patients attending US appointments. Analysis of questionnaire responses used conditional logit models and included validity checks. SETTING West Midlands, England. PARTICIPANTS 524 patients (223 in the AAA group and 301 in the general group) were recruited from the US outpatient department at University Hospital Coventry and Warwickshire. OUTCOME MEASURES Coefficients for attributes in relation to their reference levels. RESULTS The AAA group preferred to have their US performed in hospital while the general group had a preference for portable US at general practice surgeries. All patients had a strong preference for scanning by specialists, devices with a lower risk of underdiagnosis and receiving their results at the appointment where the scan takes place. The general group had a strong preference for the person performing the scan to know their medical history. CONCLUSIONS Patients being scanned for general abdominal conditions prefer to be scanned in a general practice by practitioners who know their medical history. Patients undergoing surveillance of AAA size prefer to be scanned in a hospital setting. Both groups would prefer to be informed of the scan results as soon as possible. Further research is required to explore the clinical scenarios in which targeted scanning by community practitioners would be of benefit to patients.
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Affiliation(s)
- Caron Parsons
- Warwick Medical School, University of Warwick, Coventry, UK
- Department of Radiology, University Hospitals Coventry and Warwickshire, Coventry, UK
| | | | - Joshua Pink
- National Institute for Health and Care Excellence, Manchester, UK
| | - Alice Verran
- Warwick Medical School, University of Warwick, Coventry, UK
| | | | - Charles E Hutchinson
- Warwick Medical School, University of Warwick, Coventry, UK
- Department of Radiology, University Hospitals Coventry and Warwickshire, Coventry, UK
| | - Stavros Petrou
- Warwick Medical School, University of Warwick, Coventry, UK
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Benson RA, Meecham L, Fisher O, Loftus IM. Ultrasound screening for abdominal aortic aneurysm: current practice, challenges and controversies. Br J Radiol 2018; 91:20170306. [PMID: 29582667 DOI: 10.1259/bjr.20170306] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
The UK screening programme began in 2009, and has now been expanded around the UK. Long-term follow-up of the original cohorts continues to demonstrate significant benefits for abdominal aortic aneurysm (AAA)-related and all-cause mortality , and results from the first 5 years of the formal screening programme have demonstrated similar success. Ultrasound scanning is an effective and safe screening tool for the detection of AAA, although a variety of measurement protocols are employed internationally. Key challenges for the future of the programme relate to declining incidence of screen detected aneurysms. Recent publications have demonstrated a UK incidence of only 1.34%, compared to 4.9-7.2% of men invited for screening in the original trials. Work into increasing engagement amongst the target group, and expanding screening to siblings and women is underway to address this issue. This review describes the evidence behind the screening programme, its justification in addressing AAA as a significant health problem and discusses some of the potential developments in the future.
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Affiliation(s)
- Ruth A Benson
- 1 Department of Vascular Surgery, University Hospital Coventry and Warwickshire , Coventry , UK.,2 University of Birmingham , Birmingham , UK
| | - Lewis Meecham
- 3 Department of Vascular Surgery, Department of Vascular Surgery, Birmingham Clinical Trials Unit, University of Birmingham, UK , Birmingham , UK
| | - Owain Fisher
- 1 Department of Vascular Surgery, University Hospital Coventry and Warwickshire , Coventry , UK
| | - Ian M Loftus
- 4 Department of Vascular Surgery, St Georges Hospital , London , UK
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Khashram M, Pitama S, Williman JA, Jones GT, Roake JA. Survival Disparity Following Abdominal Aortic Aneurysm Repair Highlights Inequality in Ethnic and Socio-economic Status. Eur J Vasc Endovasc Surg 2017; 54:689-696. [DOI: 10.1016/j.ejvs.2017.08.018] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Accepted: 08/20/2017] [Indexed: 12/15/2022]
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Earnshaw J, Lees T. Update on Screening for Abdominal Aortic Aneurysm. Eur J Vasc Endovasc Surg 2017; 54:1-2. [DOI: 10.1016/j.ejvs.2017.04.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Accepted: 04/05/2017] [Indexed: 02/05/2023]
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Jacomelli J, Summers L, Stevenson A, Lees T, Earnshaw JJ. Editor's Choice - Inequalities in Abdominal Aortic Aneurysm Screening in England: Effects of Social Deprivation and Ethnicity. Eur J Vasc Endovasc Surg 2017; 53:837-843. [PMID: 28416264 DOI: 10.1016/j.ejvs.2017.03.006] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Accepted: 03/07/2017] [Indexed: 10/19/2022]
Abstract
OBJECTIVE Population screening for abdominal aortic aneurysm (AAA) in men is currently ongoing in several countries. The aim was to examine the effects of deprivation and ethnicity on uptake of screening for abdominal aortic aneurysm (AAA) and prevalence of AAA. METHODS This was a review of outcomes from a population screening programme using data collected contemporaneously on a bespoke national database. Men aged 65 in two annual cohorts (2013/14 and 2014/15) were invited for AAA screening. Attendance and prevalence of AAA (aortic diameter >2.9 cm) were recorded. Results were compared according to measures of social deprivation and recorded ethnicity. RESULTS Some 593,032 men were invited and 461,898 attended for ultrasound screening; uptake 77.9%. Uptake was related to social deprivation: 65.1% in the most deprived decile, 84.1% in the least deprived: OR for least deprived 2.84, 95% CI 2.76-2.92, p<.0001. Men in deprived areas were more likely to actively decline screening: 6% versus 3.8% in the least deprived decile. AAA were twice as common in the most deprived compared with the least deprived decile: OR 2.1, 95% CI 1.77-2.27, p<.0001. AAA were more common in white British men than in black (OR 0.46, 95% CI 0.31-0.71) or Asian (OR 0.18, 95% CI 0.13-0.26) men. There was considerable local variation in all findings. CONCLUSIONS Social deprivation affects uptake of AAA screening in 65 year old men. Local factors are the most important determinants of uptake, so solutions to improve uptake must be designed at local, not national level.
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Affiliation(s)
| | | | | | - T Lees
- University Hospitals, Newcastle, UK
| | - J J Earnshaw
- Gloucestershire Hospitals NHS Foundation Trust, UK.
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11
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Jacomelli J, Summers L, Stevenson A, Lees T, Earnshaw JJ. Impact of the first 5 years of a national abdominal aortic aneurysm screening programme. Br J Surg 2016; 103:1125-31. [DOI: 10.1002/bjs.10173] [Citation(s) in RCA: 93] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2015] [Revised: 11/06/2015] [Accepted: 02/18/2016] [Indexed: 11/07/2022]
Abstract
Abstract
Background
The Abdominal Aortic Aneurysm (AAA) Screening Programme was introduced by the National Health Service (NHS) in England to reduce the rate of death from ruptured AAA in men. The programme commenced in 2009 and was implemented completely across the country in April 2013. The aim was to review the first 5 years of the programme, looking specifically at compliance and early outcome.
Methods
Men aged 65 years were invited for a single abdominal ultrasound scan. Data were entered into a bespoke database (AAA SMaRT). This was a planned analysis after the first 5 years of the programme.
Results
The summation analysis involved the first 700 000 men screened, and the first 1000 men with a large AAA referred for possible treatment. The prevalence of AAA (aortic diameter larger than 2·9 cm) in 65-year-old men was 1·34 per cent. Mean uptake was 78·1 per cent, but varied from 61·7 to 85·8 per cent across the country. Based on the Index of Multiple Deprivation, uptake was 65·1 per cent in the most deprived versus 84·1 per cent in the least deprived areas. Of the first 1000 men referred for possible treatment of a large AAA (greater than 5·4 cm), the false-positive rate was 3·2 per cent. Some 870 men underwent a planned AAA intervention (non-intervention rate 9·2 per cent), with seven deaths (perioperative mortality rate 0·8 per cent).
Conclusion
The processes in the NHS AAA Screening Programme are effective in detecting and treating men with AAA.
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Affiliation(s)
| | | | | | - T Lees
- Department of Vascular Surgery, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - J J Earnshaw
- Department of Vascular Surgery, Gloucestershire Hospitals NHS Foundation Trust, Cheltenham, UK
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12
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van Rij AM, Jones GT. Aortic aneurysm screening. Br J Surg 2015; 102:863-5; discussion 865. [DOI: 10.1002/bjs.9830] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2015] [Accepted: 03/17/2015] [Indexed: 11/07/2022]
Abstract
Still needs refining
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Affiliation(s)
- A M van Rij
- Department of Surgical Sciences, Dunedin School of Medicine, University of Otago, PO Box 56, Dunedin 9054, New Zealand
| | - G T Jones
- Department of Surgical Sciences, Dunedin School of Medicine, University of Otago, PO Box 56, Dunedin 9054, New Zealand
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