Department of Surgery, Raigmore Hospital, NHS Highland, Inverness, Scotland, UK.
Eur J Vasc Endovasc Surg. 2013 Jun;45(6):610-5. doi: 10.1016/j.ejvs.2013.02.018. Epub 2013 Mar 27.
Abdominal aortic aneurysms (AAA) are responsible for 1.4% of UK deaths. Deprivation is a risk factor for AAA. Screening reduces AAA related mortality and is cost effective if uptake remains high. The Highland aneurysm screening programme (HASP) began in 2001 offering screening to men in a sparsely populated area. The aim was to identify whether uptake varies with deprivation or rurality, in the context of an established programme.
Retrospective interrogation of HASP records was performed on all men offered screening from 2001 until 2010. Deprivation and rurality status were derived from postcode of residence (SIMD'09 and URC'08) and the relationships with screening uptake were examined.
Mean uptake over the decade was 90.1%. There was a strong association between deprivation and uptake, which ranged from 79.5% in the most deprived population to 97.5% in the least deprived (p < 0.001). The odds of men who were least deprived attending was 10.6 times higher than those who were most deprived (p < 0.001). Higher uptake was observed in more rural areas (p = 0.02). When combined in a logistic regression model, only deprivation remained significant, indicating any apparent effect of rurality was explained by deprivation. No change was observed in the mean aortic diameter of 65-year-old men or the incidence of AAA.
HASP has a high uptake even in the most deprived and rural populations, demonstrating that programme design has overcome any potential rural disadvantage. A gradient of uptake associated with deprivation remains, although even the most deprived have an uptake of almost 80%.
腹主动脉瘤（AAA）占英国死亡人数的 1.4%。贫困是 AAA 的一个风险因素。筛查可降低 AAA 相关死亡率，如果接受率保持较高水平，则具有成本效益。高地动脉瘤筛查计划（HASP）于 2001 年开始，为人口稀少地区的男性提供筛查。目的是在既定计划的背景下，确定在贫困或农村地区的接受程度是否存在差异。
对 2001 年至 2010 年期间所有接受筛查的男性进行 HASP 记录的回顾性询问。根据居住地址的邮政编码（SIMD'09 和 URC'08）得出贫困和农村程度，并检查与筛查接受程度的关系。
十年间的平均接受率为 90.1%。贫困程度与接受程度之间存在很强的关联，从最贫困人群的 79.5%到最不贫困人群的 97.5%不等（p<0.001）。最不贫困人群接受筛查的可能性是最贫困人群的 10.6 倍（p<0.001）。在更农村地区观察到更高的接受率（p=0.02）。当将这些因素结合到逻辑回归模型中时，只有贫困程度仍然具有统计学意义，表明任何明显的农村劣势效应都可以用贫困程度来解释。没有观察到 65 岁男性的主动脉直径平均值或 AAA 的发生率发生变化。
即使在最贫困和农村地区，HASP 的接受率也很高，表明计划设计克服了任何潜在的农村劣势。与贫困程度相关的接受程度梯度仍然存在，尽管最贫困的人群的接受率也接近 80%。
