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Understanding abdominal aortic aneurysm epidemiology: socioeconomic position affects outcome
  1. Sayid Zommorodi1,2,
  2. Karin Leander3,
  3. Joy Roy1,4,
  4. Johnny Steuer5,6,
  5. Rebecka Hultgren1,4
  1. 1Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
  2. 2Department of Reconstructive Plastic Surgery, Karolinska University Hospital, Stockholm, Sweden
  3. 3Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
  4. 4Department of Vascular Surgery, A2:01, Karolinska University Hospital, Stockholm, Sweden
  5. 5Department of Surgery, Section for Vascular surgery, Södersjukhuset, Stockholm, Sweden
  6. 6Department of Clinical Science and Education, Karolinska Institutet, Stockholm, Sweden
  1. Correspondence to Dr Rebecka Hultgren, Department of Vascular Surgery, A2:01, Karolinska University Hospital, Stockholm 171 76, Sweden; rebecka.hultgren{at}


Background 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.

Methods Nationwide population-based study including all individuals with iAAA or rAAA in Sweden during 2001–2015.

Results 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).

Conclusion 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.

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

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  • Contributors Conception and design: SZ, RH, KL. Analysis and interpretation: SZ, RH, KL. Data collection: SZ, RH, KL. Statistical analysis: SZ. Writing the manuscript: SZ, RH. Critical revision: SZ, RH, KL, JR, JS. Approval of manuscript and agreement of content: SZ, RH, KL, JR, JS.

  • Funding RH, SZ and JR had financial support from Swedish Heart–Lung Foundation and through the regional agreement on medical training and clinical research (ALF) between the Stockholm County Council and Karolinska Institutet for the submitted work. JR had financial support from the Stockholm City Council.

  • Competing interests None declared.

  • Patient consent Not required.

  • Ethics approval This study was approved by the Regional Ethics Review Board in Stockholm (registration no. 2015/2108-31/5) and complies with the Declaration of Helsinki.

  • Provenance and peer review Not commissioned; externally peer reviewed.