Explaining the decrease in mortality from abdominal aortic aneurysm rupture
Explaining the decrease in mortality from abdominal aortic aneurysm rupture
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DOI：
10.1002/bjs.8698
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发表时间：
2012-05-01
影响因子：
9.6
通讯作者：
Powell, J. T.
中科院分区：
文献类型：
--
作者：
Anjum, A.;von Allmen, R.;Powell, J. T.
背景：据报道，20 世纪 80 年代和 90 年代，腹主动脉瘤 (AAA) 死亡率稳步上升，但现在正在迅速下降。本文对近期 AAA 破裂死亡率下降的原因进行了调查。方法：对英格兰和威尔士的死亡率、入院率和手术情况进行常规统计调查。所有数据均按年龄标准化。吸烟、高血压和高胆固醇血症（他汀类药物）治疗的趋势以及死亡率的回归系数可从公共来源获取 65 岁以上人群的信息。该年龄组中避免的 AAA 破裂死亡人数是通过使用 IMPACT 方程估算的：避免的死亡人数 =（指数年的死亡人数）x（风险因素下降）x β 系数。结果：从 1997 年起，AAA 破裂造成的死亡人数急剧下降，男性中几乎两倍。因选择性 AAA 修复而入院的人数略有增加（从每 10 万人 40 人增加到 45 人），这完全归因于 75 岁及以上老年人接受的手术增多（P < 0.001）。各年龄段因破裂 AAA 入院的人数从每 10 万人中 18.6 人下降到 13.5 人，但接受紧急修复的比例保持不变。自 1997 年起，65 岁以上人群因动脉瘤破裂死亡率已从每 10 万人中 65.9 人下降到 44.6 人。据估计，每 10 万人口中有 8-11 人因吸烟率的降低而避免了死亡，而选择性 AAA 修复数量的增加也避免了类似的死亡人数。对血压和血脂控制效果的估计尚不确定。结论：自 1997 年以来 AAA 破裂发生率的下降主要归因于吸烟率的变化以及 75 岁及以上人群选择性 AAA 修复术的增加。
Background: A steady rise in mortality from abdominal aortic aneurysm (AAA) was reported in the 1980s and 1990s, although this is now declining rapidly. Reasons for the recent decline in mortality from AAA rupture are investigated here.Methods: Routine statistics for mortality, hospital admissions and procedures in England and Wales were investigated. All data were age-standardized. Trends in smoking, hypertension and treatment for hypercholesterolaemia (statins), together with regression coefficients for mortality, were available from public sources for those aged at least 65 years. Deaths from ruptured AAA avoided in this age group were estimated by using the IMPACT equation: deaths avoided = (deaths in index year) x (risk factor decline) x beta-coefficient.Results: From 1997, deaths from ruptured AAA have decreased sharply, almost twofold in men. Hospital admissions for elective AAA repair have increased modestly (from 40 to 45 per 100 000 population), attributable entirely to more procedures in those aged 75 years and over (P < 0.001). Admissions for ruptured AAA have declined from 18.6 to 13.5 per 100 000 population, across all ages, with the proportion offered and surviving emergency repair unchanged. From 1997, mortality from ruptured aneurysm in those aged at least 65 years has fallen from 65.9 to 44.6 per 100 000 population. An estimated 8-11 deaths per 100 000 population were avoided by a reduced prevalence of smoking and a similar number from an increase in the number of elective AAA repairs. Estimates for the effects of blood pressure and lipid control are uncertain.Conclusion: The reduction in incidence of ruptured AAA since 1997 is attributable largely to changes in smoking prevalence and increases in elective AAA repair in those aged 75 years and over.