Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.
Department of Reconstructive Plastic Surgery, Karolinska University Hospital, Stockholm, Sweden.
J Epidemiol Community Health. 2018 Oct;72(10):904-910. doi: 10.1136/jech-2018-210644. Epub 2018 Jul 2.
Low socioeconomic position (SEP) has been demonstrated to negatively influence outcome in several cardiovascular patient groups. The aim of this study was to analyse time trends of incidence of intact abdominal aortic aneurysm (iAAA) and ruptured AAA (rAAA), respectively, and to investigate whether SEP had any influence on the probability to present with rupture and, finally, to determine the impact of SEP on outcome.
Nationwide population-based study including all individuals with iAAA or rAAA in Sweden during 2001-2015.
The number of individuals with an AAA was 41 222; the majority were identified as iAAA 33 254 (80.7%) and 7968 (19.3%) as rAAA. Time trends showed decreasing incidence of rAAA but increase in iAAA during the study period. Individuals with low income or low educational level were more likely to present with a rAAA rather than iAAA: OR 2.16 (95 % CI 1.98 to 2.36, p<0.001) and OR 1.33 (95 % CI 1.21 to 1.46, p<0.001), respectively. Low income was also associated with increased 90-day mortality and 1-year mortality after treatment for rAAA, OR 1.42 (95% CI 1.07 to 1.89, p=0.014) and OR 1.39 (95% CI 1.13 to 1.97, p=0.005).
This large nationwide study showed a decreasing incidence of rAAA. Individuals with low SEP were found to have an augmented risk of presenting with rAAA rather than iAAA and, in addition, to fare worse after repair. Consequently, SEP should be regarded as a relevant risk factor that should be included in considerations for improved care flow of patients with AAA.
低社会经济地位（SEP）已被证明会对多个心血管病患者群体的预后产生负面影响。本研究旨在分析完整腹主动脉瘤（iAAA）和破裂性 AAA（rAAA）的发病率的时间趋势，并探讨 SEP 是否会对破裂的可能性产生影响，最后确定 SEP 对预后的影响。
本研究为一项全国范围内的基于人群的研究，纳入了 2001 年至 2015 年期间在瑞典患有 iAAA 或 rAAA 的所有个体。
共纳入 41222 名 AAA 患者，其中大多数为 iAAA（33254 例，80.7%）和 rAAA（7968 例，19.3%）。时间趋势显示，研究期间 rAAA 的发病率呈下降趋势，而 iAAA 的发病率则呈上升趋势。收入低或教育程度低的个体更有可能表现为 rAAA 而不是 iAAA：OR 2.16（95%CI 1.98 至 2.36，p<0.001）和 OR 1.33（95%CI 1.21 至 1.46，p<0.001）。低收入也与 rAAA 患者的 90 天死亡率和 1 年死亡率增加相关，OR 1.42（95%CI 1.07 至 1.89，p=0.014）和 OR 1.39（95%CI 1.13 至 1.97，p=0.005）。
本项大型全国性研究显示 rAAA 的发病率呈下降趋势。低 SEP 的个体发生 rAAA 的风险增加，而不是 iAAA，并且在修复后预后更差。因此，SEP 应被视为一个相关的危险因素，应纳入 AAA 患者的护理流程改进考虑因素中。
