IS SCREENING FOR ABDOMINAL AORTIC-ANEURYSM ACCEPTABLE TO THE POPULATION - SELECTION AND RECRUITMENT TO HOSPITAL-BASED MASS-SCREENING FOR ABDOMINAL AORTIC-ANEURYSM

Background The aim of the study was to analyse whether the selection a nd recruitment for hospital-based mass screening for abdominal aortic aneurysms (AAA) is acceptable for the population according to the crit eria 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 atten dance rate was 76 per cent; 4.2 per cent had AAA. Men with cardiopulmo nary and vascular diseases had higher attendance rate (80.5 per cent), and prevalence of AAA (9.1 per cent). Men with potentially mobility-d isabling diseases also had a higher attendance rate (80.4 per cent). H owever, possible unfavourable social selection was noticed in the grou p 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 per cent. More A AA were found at secondary scans (6.3 per cent compared with 3.9 per c ent). Conclusion The attendance rate fell markedly with age, but the r ecruitment was high even at the age of 73, and travel distance and soc ial class did not markedly influence uptake. A positive morbidity sele ction to screening for AAA was observed for cardiovascular or pulmonar y diseases and potentially mobility-disabling diseases. Furthermore, h igher prevalence of AAA was found for initial nonattenders. Thus, scre ening for AAA seems acceptable to the population, and extra efforts to increase the attendance are beneficial without increased costs per di agnosed AAA. Finally, if mass-screening proves to be cost-ineffective, selective screening of patients with hypertension or ischaemic heart disease might be beneficial.