Section of Vascular Surgery, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden; Department of Clinical Science and Education, Karolinska Institutet at Södersjukhuset, Karolinska Institutet, Stockholm, Sweden.
Br J Surg. 2014 Apr;101(5):481-7. doi: 10.1002/bjs.9434. Epub 2014 Feb 26.
A population-based screening programme for abdominal aortic aneurysm (AAA) started in 2010 in Stockholm County, Sweden. This present study used individual data from Sweden's extensive healthcare registries to identify the reasons for non-participation in the AAA screening programme.
All 65-year-old men in Stockholm are invited to screening for AAA; this study included all men invited from July 2010 to July 2012. Participants and non-participants were compared for socioeconomic factors, travel distance to the examination centre and healthcare use. The influence of these factors on participation was analysed using univariable and multivariable logistic regression models.
The participation rate for AAA screening was 77·6 per cent (18 876 of 24 319 men invited). The prevalence of AAA (aortic diameter more than 2·9 cm) among participants was 1·4 per cent. The most important reasons for non-participation in the multivariable regression analyses were: recent immigration (within 5 years) (odds ratio (OR) 3·25, 95 per cent confidence interval 1·94 to 5·47), low income (OR 2·76, 2·46 to 3·10), marital status single or divorced (OR 2·23, 2·08 to 2·39), low level of education (OR 1·28, 1·16 to 1·40) and long travel distance (OR 1·23, 1·10 to 1·37). Non-participants had a higher incidence of stroke (4·5 versus 2·8 per cent; P < 0·001) and chronic pulmonary disease (2·9 versus 1·3 per cent; P < 0·001). Daily smoking was more common in residential areas where the participation rate for AAA screening was low.
Efforts to improve participation in AAA screening should target the groups with low income, a low level of education and immigrants. The higher morbidity in the non-participant group, together with a higher rate of smoking, make it probable that this group also has a high risk of AAA.
2010 年，瑞典斯德哥尔摩县启动了一项基于人群的腹主动脉瘤（AAA）筛查计划。本研究利用瑞典广泛的医疗保健登记数据，确定了不参与 AAA 筛查计划的原因。
所有 65 岁的斯德哥尔摩男性都被邀请参加 AAA 筛查；本研究包括 2010 年 7 月至 2012 年 7 月期间邀请的所有男性。比较参与者和非参与者的社会经济因素、前往检查中心的旅行距离和医疗保健使用情况。使用单变量和多变量逻辑回归模型分析这些因素对参与的影响。
AAA 筛查的参与率为 77.6%（24319 名受邀男性中有 18876 人参加）。参与者中 AAA（主动脉直径大于 2.9cm）的患病率为 1.4%。多变量回归分析中最重要的不参与原因是：近期移民（5 年内）（比值比（OR）3.25，95%置信区间 1.94 至 5.47）、低收入（OR 2.76，2.46 至 3.10）、单身或离异（OR 2.23，2.08 至 2.39）、低教育水平（OR 1.28，1.16 至 1.40）和长距离旅行（OR 1.23，1.10 至 1.37）。不参与者中风（4.5%对 2.8%；P<0.001）和慢性肺部疾病（2.9%对 1.3%；P<0.001）的发病率更高。AAA 筛查参与率较低的居民区，日常吸烟更为普遍。
提高 AAA 筛查参与率的努力应针对低收入、低教育水平和移民群体。不参与者的发病率较高，加上吸烟率较高，可能表明该群体也有较高的 AAA 风险。
