Ngetich E, Ward J, Cassimjee I, Lee R, Handa A
University of Oxford, Department of Surgical Sciences, John Radcliffe Hospital OX3, 9DU Oxford, United Kingdom.
University of Witwatersrand, Department of Surgery, Private Bag X2600, Houghton, Johannesburg, South Africa.
J West Afr Coll Surg. 2020 Jan-Mar;10(1):3-14. doi: 10.4103/jwas.jwas_15_21. Epub 2022 Mar 5.
The incidence of abdominal aortic aneurysms (AAAs) in high-income countries has been declining in the last three decades. However, in most low-income and middle-income countries especially in Africa, little is known about its burden. The absence of screening services for AAA in African countries makes it difficult to detect and promptly manage AAA before rupture, which has significant implications for mortality. This study sought to systematically assess the prevalence of AAA amongst patients visiting hospitals in Africa and evaluate its epidemiological pattern.
A systematic review was performed on the EMBASE, GLOBAL HEALTH, MEDLINE, and PUBMED databases. The review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses statement standards and protocol registered with PROSPERO (CRD42020162214). A data extraction tool was used to get relevant information from these studies. Quality assessment and risk of bias were performed using the Newcastle Ottawa Scale for cross-sectional studies. Results were summarised in tables, figures, and a forest plot. A narrative synthesis approach of the articles was taken.
Two hundred and sixty-one studies were identified and after the exclusion of 246, a final 15 were deemed suitable for analysis. A total of 4012 participants were screened for AAA and of these, 129 cases were identified. The prevalence of AAA in these studies ranged from 0.7 to 6.4%. Male participants accounted for 115 (89.1%) of the cases. There was a wide age range (31-72 years) reflective of both its possible infective and degenerative aetiology. AAA was reported to be associated with hypertension, smoking, advanced age, coronary artery disease, and HIV infection. There was no association between AAA and diabetes. Over 50% of cases were identified incidentally. About one-third (23-54%) of the participants presented aortic rupture with a mortality rate ranging between 65 and 72%.
AAA prevalence in Africa is probably higher than the current thinking as there is no baseline data to compare with. Aetiologically, AAA was shown to be associated with hypertension, smoking, coronary artery disease, and possibly infectious pathologies like HIV. Large epidemiological studies would help better characterise AAA in this setting. Lastly, efforts targeting the reduction of the risk factors for AAA would go a long way in reducing the burden of AAA.
在过去三十年中，高收入国家腹主动脉瘤（AAA）的发病率一直在下降。然而，在大多数低收入和中等收入国家，尤其是非洲，人们对其负担了解甚少。非洲国家缺乏针对AAA的筛查服务，这使得在AAA破裂前难以检测和及时处理，对死亡率有重大影响。本研究旨在系统评估非洲医院就诊患者中AAA的患病率，并评估其流行病学模式。
对EMBASE、全球卫生、MEDLINE和PUBMED数据库进行了系统评价。该评价按照系统评价和Meta分析的首选报告项目声明标准进行，并遵循在PROSPERO注册的方案（CRD42020162214）。使用数据提取工具从这些研究中获取相关信息。采用纽卡斯尔渥太华横断面研究量表进行质量评估和偏倚风险评估。结果以表格、图表和森林图的形式进行总结。对文章采用叙述性综合方法。
共识别出261项研究，排除246项后，最终15项被认为适合分析。共有4012名参与者接受了AAA筛查，其中129例被确诊。这些研究中AAA的患病率在0.7%至6.4%之间。男性参与者占病例的115例（89.1%）。年龄范围很广（31 - 72岁），反映了其可能的感染性和退行性病因。据报道，AAA与高血压、吸烟、高龄、冠状动脉疾病和HIV感染有关。AAA与糖尿病之间没有关联。超过50%的病例是偶然发现的。约三分之一（23 - 54%）的参与者出现主动脉破裂，死亡率在65%至72%之间。
由于没有基线数据可供比较，非洲AAA的患病率可能高于目前的认知。从病因学角度来看，AAA与高血压、吸烟、冠状动脉疾病以及可能的感染性疾病如HIV有关。大规模的流行病学研究将有助于更好地描述这种情况下的AAA。最后，针对降低AAA风险因素的努力将在很大程度上减轻AAA的负担。
