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J Epidemiol Community Health. 2018 Oct;72(10):904-910. doi: 10.1136/jech-2018-210644. Epub 2018 Jul 2.

Understanding abdominal aortic aneurysm epidemiology: socioeconomic position affects outcome.

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Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.
Department of Reconstructive Plastic Surgery, Karolinska University Hospital, Stockholm, Sweden.
Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
Department of Vascular Surgery, A2:01, Karolinska University Hospital, Stockholm, Sweden.
Department of Surgery, Section for Vascular surgery, Södersjukhuset, Stockholm, Sweden.
Department of Clinical Science and Education, Karolinska Institutet, Stockholm, Sweden.



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.


epidemiology of cardiovascular disease; social inequalities; socio-economic; vascular disease


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