© 1998 Faculty of Public Health Medicine of the Royal Colleges of Physicians of the United Kingdom
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Is screening for abdominal aortic aneurysm acceptable to the population? Selection and recruitment to hospital-based mass screening for abdominal aortic aneurysm
Jes S. Lindholt, Research Fellow*,
Svend Juul, Senior Lecturer
Eskild W. Henneberg, Medical Director*
Helge Fasting, Consultant Surgeon*
*Department of Vascular Surgery, Viborg Hospital Viborg, Denmark
Department of Epidemiology and Social Medicine, University of Aarhus Denmark
Address correspondence to Dr Jes S. Lindholt, Lærkevej 11, 8900 Randers, Denmark.
BACKGROUND: The aim of the study was to analyse whether the selection and recruitment for hospital-based mass screening for abdominal aortic aneurysms (AAA) is acceptable for the population according to the criteria from the Council of Europe.
METHODS: A random sample of 4404 65-73-year-old males were invited to hospital-based mass screening for AAA. As methods of secondary recruitment, they could change their time of appointment and non-responders were reinvited once.
RESULTS: The attendance rate was 76 per cent; 4.2 per cent had AAA. Men with cardiopulmonary and vascular diseases had higher attendance rate (80.5 per cent), and prevalence of AAA (9.1 percent). Men with potentially mobility-disabling diseases also had a higher attendance rate (80.4 per cent). However, possible unfavourable social selection was noticed in the group of retired men with no information of former occupation. They had 68.5 per cent attendance, and 7.6 per cent AAA. If true, this selection decreases the number of potentially diagnosed AAA by only 2 per cent. Opportunity of revised appointment and reinvitation of non-responders increased the primary attendance of 65 per cent to 76 percent. More AAA were found at secondary scans (6.3 percent compared with 3.9 percent).
CONCLUSIONS: The attendance rate fell markedly with age, but the recruitment was high even at the age of 73, and travel distance and social class did not markedly influence uptake. A positive morbidity selection to screening for AAA was observed for cardiovascular or pulmonary diseases and potentially mobility-disabling diseases. Furthermore, higher prevalence of AAA was found for initial nonattenders. Thus, screening for AAA seems acceptable to the population, and extra efforts to increase the attendance are beneficial without increased costs per diagnosed AAA. Finally, if mass-screening proves to be cost-ineffective, selective screening of patients with hypertension or ischaemic heart disease might be beneficial.
Keywords: Mass screening, abdominal aortic aneurysm, acceptance rate, attendance rate, selection, high risk
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