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Published on: September 19, 2018

Population based randomised controlled trial on impact of screening on mortality from abdominal aortic aneurysm

Paul E Norman1, Konrad Jamrozik, Michael M Lawrence-Brown

  • 1School of Surgery and Pathology, University of Western Australia, Fremantle Hospital, PO Box 480, Fremantle, WA 6959, Australia. pnorman@cyllene.uwa.edu.au

BMJ (Clinical Research Ed.)
|November 17, 2004
PubMed

Insights

Screening for abdominal aortic aneurysms in men aged 65-83 did not reduce overall mortality. However, screening showed potential benefits for men aged 65-75, highlighting the importance of age targeting.

Area of Science:

  • Vascular Surgery
  • Public Health Screening
  • Epidemiology

Background:

  • Abdominal aortic aneurysm (AAA) is a significant cause of mortality in older men.
  • Effective screening strategies are crucial for early detection and intervention.
  • Previous studies have yielded mixed results on the effectiveness of AAA screening programs.

Purpose of the Study:

  • To evaluate the impact of ultrasound screening for abdominal aortic aneurysms on mortality in men aged 65-83 years.
  • To determine if population-based screening reduces overall death rates from AAA.

Main Methods:

  • A community-based, randomized controlled trial involving 41,000 men aged 65-83 years in Western Australia.
  • Participants were randomized to either an intervention group (invitation to ultrasound screening) or a control group.
  • Intention-to-treat analysis of age-standardized mortality was conducted over a five-year follow-up period.

Main Results:

  • The overall mortality ratio for AAA deaths between the intervention and control groups was 0.61 (95% CI 0.33 to 1.11), indicating no statistically significant reduction at the population level.
  • Men aged 65-75 years in the intervention group experienced a significant reduction in AAA mortality, with a ratio of 0.19 (95% CI 0.04 to 0.89).
  • The intervention group had twice the rate of elective AAA surgery compared to the control group (107 vs. 54).

Conclusions:

  • Population-based screening for abdominal aortic aneurysms in men aged 65-83 years was not effective in reducing overall mortality.
  • The effectiveness of screening is highly dependent on selecting the appropriate target age group and excluding ineligible individuals.
  • The potential benefits of population-based screening may be limited in communities with a high rate of current elective AAA surgery.
Abstract

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