A new study from the University of Sheffield, published in the British Journal of Surgery (BJS), has found clear evidence of socioeconomic disparities in operation rates and survival after surgery for abdominal aortic aneurysm (AAA).
The study, funded by the National Institute for Health Research (NIHR), found that amongst admitted patients, men from more deprived areas were more likely to die in hospital without having their aneurysm repaired than men from less deprived areas.
Amongst men who had aneurysm surgery, this was more likely to be for a ruptured aneurysm in men from more deprived compared with less deprived areas.
In men who had had a repair for an aneurysm that had not ruptured, those from more deprived areas were more likely to have this carried out as an emergency procedure than men from less deprived areas.
Additionally, the research highlighted that the death rate following surgery was higher in men from more deprived areas, although the magnitude of the increased risk diminished with increasing age.
In women, the association between socioeconomic deprivation and survival following surgery was less clear.
Ravi Maheswaran (University of Sheffield, Sheffield, UK), who led the study, remarked on the findings: “The disparities that we have found are clearly unacceptable. There is a national NHS screening programme which offers screening for AAA to all men when they turn 65 but uptake is lower in more deprived areas.
“We know that this could lead to men living in deprived areas having later diagnosis, greater risk of emergency surgery and poorer outcomes, including death.”
The Sheffield study was conducted by researchers from the University’s School of Health and Related Research (ScHARR). Additionally, it found that planned surgery rates (calculated as a rate for the population) were higher in middle-aged men living in deprived areas, as expected. However, planned surgery rates were lower in older men in more deprived areas. Instead, there were higher emergency surgery rates, including surgery for ruptured aneurysm, in more deprived areas.
Co-investigator on the study Jonathan Michaels (University of Sheffield, Sheffield, UK) commented on what should happen next: “Interventions that can increase the uptake of aneurysm screening in socioeconomically deprived areas should lead to finding and surgically treating more men with aneurysms in these areas.
“Earlier identification of men with aneurysms should also help men who would benefit from lifestyle changes. This could include stopping smoking, eating healthily, exercising regularly and maintaining a healthy weight which will help to reduce operative risks and cardiovascular mortality.”