Socioeconomic Position, Comorbidity, and Mortality in Aortic Aneurysms: A 13-Year Prospective Cohort Study

Background

To evaluate factors associated with incidence and 3-year all-cause mortality in patients with aortic aneurysm (AA). The design is sex and age-stratified (60–79 and 80–90 years) prospective cohort. By using the population register, we constituted a cohort of all men and women born between 1900 and 1930 and living in Scania by 1991, and followed them for 13 years. Identification of AA was based on hospital discharge diagnosis obtained from the Swedish Patient Register or from the information on death certificates from the Cause of Death Register.

Methods

We applied stepwise Cox regression and investigated both AA incidence (1991-2003) as well as 3-year survival after the first hospitalization for AA.

Results

We found an inverse relation between AA incidence and previous hospitalization by diabetes mellitus in women (hazard ratio [HR]: 0.41; 95% confidence interval [CI]: 0.19–0.88) and in men (HR: 0.38; 95% CI: 0.24–0.61) aged 60–79 years. Three-year all-cause mortality after diagnosis of AA was 58.6% in women, 50.2% in men, 72.9% in octogenarians, and 43.7% for nonoctogenarians. Low income, chronic respiratory diseases, cerebrovascular diseases, dementia, systemic connective tissue disorders, renal failure, and malignant neoplasms were independent factors for mortality in 60–79-year-old men with AA.

Conclusions

Inferior socioeconomic position is associated with increased 3-year all-cause mortality in 60–79-year-old men with AA.

Introduction

Development of aortic aneurysm (AA) is associated with old age, male gender, smoking, hereditary disposition, hypertension, atherosclerosis, and occurrence of other aneurysms. The increased risk of premature death seems mostly to be dependent on ischemic heart disease and other comorbidities rather than rupture.¹ However, the role of other common comorbidities such as cerebrovascular diseases,2, 3 chronic obstructive pulmonary disease (COPD),4, 5 and cancer⁶ forms associated with smoking as contributing factors to death is less well studied. The specific pathogenesis in aneurysm development involves proteolytic degradation of collagen and elastin in the aortic wall,7, 8 and its possible associated comorbidities seems to be much less explored.

Scania is an area in the southernmost part of Sweden that is considering launching a screening project for abdominal AA on 65–year-old men. Therefore, an inventory study on incidence, mortality, and associated comorbidity in patients with AAs was warranted, as it may provide relevant information for this project.

Linkage of large databases has made it possible to evaluate all 60–90-year-old individuals in the population of Scania with respect to in-hospital diagnoses during a follow-up period of 13 years. Therefore, the aim of the present large population-based study was to estimate (i) the overall incidence of in-hospital diagnosis of AA between 1991 and 2003 and (ii) the 3-year survival among such patients. When doing so, we also try to explore the association between, on the one hand, individual patient characteristics such as age, gender, socioeconomic position, and comorbidities and, on the other hand, the incidence and mortality after in-hospital diagnosis of AA.