Jacomelli J, Summers L, Stevenson A, Lees T, Earnshaw J J
Public Health England, UK.
University Hospitals, Newcastle, UK.
Eur J Vasc Endovasc Surg. 2017 Jun;53(6):837-843. doi: 10.1016/j.ejvs.2017.03.006. Epub 2017 Apr 14.
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.
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.
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.
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.
目前，多个国家正在对男性进行腹主动脉瘤（AAA）群体筛查。其目的是研究贫困程度和种族对腹主动脉瘤（AAA）筛查接受率及AAA患病率的影响。
这是一项对群体筛查项目结果的回顾性研究，使用了在一个定制的国家数据库中同期收集的数据。邀请了两个年度队列（2013/14年和2014/15年）中65岁的男性进行AAA筛查。记录了筛查的参与情况和AAA（主动脉直径>2.9厘米）的患病率。根据社会贫困程度指标和记录的种族对结果进行了比较。
约593,032名男性被邀请参加超声筛查，461,898人参加；接受率为77.9%。接受率与社会贫困程度有关：在最贫困的十分位数人群中为65.1%，在最不贫困的人群中为84.1%；最不贫困人群的比值比为2.84，95%置信区间为2.76 - 2.92，p<0.0001。贫困地区的男性更有可能主动拒绝筛查：在最贫困的十分位数人群中为6%，而在最不贫困的十分位数人群中为3.8%。与最不贫困的十分位数人群相比，最贫困人群中AAA的患病率是其两倍：比值比为2.1，95%置信区间为1.77 - 2.27，p<0.0001。AAA在英国白人男性中比在黑人男性（比值比为0.46，95%置信区间为0.31 - 0.71）或亚洲男性（比值比为0.18，95%置信区间为0.13 - 0.26）中更为常见。所有结果在当地都存在相当大的差异。
社会贫困程度影响65岁男性对AAA筛查的接受情况。当地因素是接受率的最重要决定因素，因此提高接受率的解决方案必须在地方而非国家层面设计。
