Poorer self assessed health in a prospective study of men with screen detected abdominal aortic aneurysm: a predictor or a consequence of screening outcome?

Abstract

Study objectives: To assess the extent to which poorer self assessed health in men in whom an abdominal aortic aneurysm (AAA) is detected at screening is a consequence or a predictor of screening outcome. Design: Prospective study. Setting: Community based screening. Participants: 23 654 men who attended for AAA screening as part of the UK multicentre aneurysm screening study completed a measure of self assessed health before screening. A total of 1156 had an aneurysm detected. A sub-sample of screened men (571 with an aneurysm and 609 with a normal aorta) also completed the measure of self assessed health six weeks after screening. Main results: Men in whom an aneurysm was detected at screening perceived their health to be poorer before screening than those with a normal aorta. Adjusting for risk factors for AAA made no difference to this result: self assessed health remained a strong predictor of having an aneurysm (odds ratio 1.7 comparing the extreme quartiles of self assessed health, 95% confidence intervals: 1.4 to 2.0). Men with an aneurysm also perceived their health to be poorer after screening had detected their aneurysms, but only to an extent in line with their pre-screening perceptions. Conclusions: Self assessed health seems to predict having an aortic aneurysm, independently of known risk factors. This emphasises the importance of assessing baseline perceptions of health to prevent erroneously inferring that poorer self assessed health in those who screen positive is a consequence as compared with a predictor of screening outcome.

Final follow-up of the Multicentre Aneurysm Screening Study (MASS) randomized trial of abdominal aortic aneurysm screening

“…Investigation of the accuracy of cause of death coding on the death certificates in the first 4 years of follow‐up was carried out by an independent mortality working party blinded to group allocation, and showed that inaccuracies in coding had a minimal impact on study outcomes5. The quality‐of‐life data collected in the trial around the time of screening showed no clear adverse (or beneficial) effects of screening, nor any long‐term effects after surgery5, 31.…”

Screening for risk of cardiovascular disease is not associated with mental distress

“…One general methodological problem is the lack of information on the level of distress before screening. This information is essential to assess whether distress after screening is a consequence of the screening procedure or existed before screening-as discussed in a study of distress in relation to screening for aortic aneurism (Marteau et al, 2004;McCaffery and Barrett, 2004). Another important question is whether the impact of screening on mental distress is modified by degree of information and support to the individual after screening (Connelly et al, 1998).…”

How cost-effective is screening for abdominal aortic aneurysms?

“…No further adjustment is made to quality of life for those receiving positive screening results or undergoing AAA repair, as published evidence does not support long-term differences in quality-of-life outcomes in these groups. 21,22 Incremental life-years are estimated as life-years gained from a reduction in all-cause mortality.…”