Modeling the burden of abdominal aortic aneurysm (AAA) in Europe in 2013

Objectives

To estimate the number of prevalent cases of abdominal aortic aneurysm (AAA)and deaths attributable to AAA in five major European Union (5EU) markets:France, Germany, Italy, Spain, and the United Kingdom (UK).

Methods

We used disease modeling software, DisMod II (World Health Organization), toassess AAA burden via a multi-state life table where differential equationsdefine relationships between incidence, prevalence, and disease-specificmortality. Market-specific input data included age- and sex-specific populationstructure, age- and sex-specific all-cause mortality, and cubic splineinterpolation of size- and sex-specific AAA prevalence. Other input dataconsisted of relative risk (RR) estimates of death for persons with AAAcompared with persons without AAA, adjusted for age, ethnicity, height, weight,smoking, and cardiovascular disease history.

Results

We estimated 2,484,058 prevalent cases in the 5EU in 2013 (90% CI:2,282,702–2,638,106), resulting in 48,805 deaths attributable to AAA (90% CI:39,924–54,291). In the combined 5EU, females accounted for 20.2% of prevalentcases and 43.2% of deaths. France had the lowest number of prevalent cases(581.8 per 100,000 population) and deaths (11.0 per 100,000 population) amongthe 5EU markets, while Italy had the highest number of prevalent cases (1,103.7per 100,000 population) and deaths (22.3 per 100,000 population). The number ofdeaths attributable to AAA in Italy represented 28.0% of the 5EU total, despiteItaly accounting for only 19.3% of the 5EU population in 2013.

Conclusions

Our study reveals that the burden of AAA among the 5EU markets is most severein Italy, which accounted for the highest number of both prevalent cases anddeaths attributable to AAA in the 5EU. Throughout the 5EU, females accountedfor a disproportionately high percentage of deaths despite constituting a lowpercentage of prevalent cases. Consequently, current screening guidelinesshould target both sexes, rather than males only.