Department of Life, Public Health and Environmental Sciences, University of L'Aquila, 67100 L'Aquila, Italy.
Vascular Surgery, G. Mazzini di Teramo Hospital, Local Health Unit, 64100 Teramo, Italy.
Int J Environ Res Public Health. 2022 Jan 5;19(1):591. doi: 10.3390/ijerph19010591.
Abdominal aortic aneurysm (AAA) is a major public health problem. In the last decade, in some European countries, abdominal aortic screening (AAS) is emerging as a potential prevention for the rupture of AAA. The goals of our study were to estimate AAA prevalence and risk factors in males and females in a central Italian population, also defining the cost-effectiveness of AAS programs. A pilot study screening was conducted between 1 January 2015 and 31 December 2019 in the municipality of Teramo (Abruzzo Region, Italy) in a group of men and women, ranging from the age of 65 to 79, who were not previously operated on for AAA. The ultrasound was performed by means of Acuson sequoia 512 Simens with a Convex probe. The anterior posterior of the infra-renal aorta was evaluated. The odds ratio values (ORs) were used to evaluate the risk of AAA, and the following determinants were taken into consideration: gender, smoke use, hypertension, and ischemic heart disease. We also estimated the direct costs coming from aneurysmectomy (surgical repair or endovascular aneurysms repair-EVAR). A total of 62 AAA (2.7%, mean age 73.8 ± 4.0) were diagnosed, of which 57 were in men (3.7%, mean age 73.6 ± 4.0) and 5 were in women (0.7%, mean age 74.3 ± 4.1). Male gender and smoke use are more important risk factors for AAA ≥ 3 cm, respectively: OR = 5.94 (2.37-14.99, < 0.001) and OR = 5.21 (2.63-10.30, < 0.000). A significant increase in OR was noted for AAA ≥ 3 cm and cardiac arrhythmia and ischemic heart disease, respectively: OR = 2.81 (1.53-5.15, < 0.000) and OR = 2.76 (1.40-5.43, = 0.006). Regarding the cost analysis, it appears that screening has contributed to the reduction in costs related to urgency. In fact, the synthetic indicator given by the ratio between the DRGs (disease related group) relating to the emergency and those of the elective activity went from 1.69 in the year prior to the activation of the screening to a median of 0.39 for the five-year period of activation of the screening. It is important to underline that the results of our work confirm that the screening activated in our territory has led to a reduction in the expenditure for AAA emergency interventions, having increased the planned interventions. This must be a warning for local stakeholders, especially in the post-pandemic period, in order to strengthen prevention.
腹主动脉瘤（AAA）是一个重大的公共卫生问题。在过去的十年中，在一些欧洲国家，腹主动脉筛查（AAS）作为 AAA 破裂的潜在预防措施正在出现。我们研究的目的是评估意大利中部人群中男性和女性的 AAA 患病率和危险因素，并确定 AAS 计划的成本效益。在意大利阿布鲁佐地区特腊莫市（Teramo），我们进行了一项试点筛查研究，研究对象为年龄在 65 至 79 岁之间、此前未因 AAA 接受过手术的男性和女性。使用西门子 Acuson sequoia 512 型超声仪和凸阵探头进行超声检查。评估了肾下主动脉的前后径。使用比值比（OR）值来评估 AAA 的风险，考虑了以下决定因素：性别、吸烟、高血压和缺血性心脏病。我们还估计了动脉瘤切除术（手术修复或血管内动脉瘤修复-EVAR）带来的直接成本。共诊断出 62 个 AAA（2.7%，平均年龄 73.8±4.0），其中 57 个为男性（3.7%，平均年龄 73.6±4.0），5 个为女性（0.7%，平均年龄 74.3±4.1）。男性性别和吸烟是 AAA≥3cm 的更重要的危险因素，OR值分别为 5.94（2.37-14.99， < 0.001）和 5.21（2.63-10.30， < 0.000）。AAA≥3cm 和心律失常及缺血性心脏病的 OR 值显著增加，OR 值分别为 2.81（1.53-5.15， < 0.000）和 2.76（1.40-5.43，=0.006）。关于成本分析，筛查似乎有助于降低与紧急情况相关的成本。事实上，与急症活动相关的疾病相关组（DRG）与择期活动相关的 DRG 的比值，从筛查激活前一年的 1.69 降至筛查激活五年期间的中位数 0.39。值得强调的是，我们工作的结果证实，在我们的地区开展的筛查导致 AAA 紧急干预支出减少，同时增加了计划干预。这对当地利益相关者来说是一个警示，尤其是在大流行后时期，以便加强预防。
