Background: Temporal trends of infrarenal aortic diameters and their association with long-term mortality were explored in a population-based abdominal aortic aneurysm (AAA) screening programme. Additionally, changes in risk factor distribution and outcomes among the individuals with an AAA were analysed over the 14-year study period.
Methods: In this population-based cohort study between 2010 and 2023, all 65-year-old men who had been invited to screening for AAA were studied (152 000). Aortic diameter and date of death were extracted from the regional screening database.
Results: Some 117 120 men were examined, with reductions in mean(s.d.) aortic diameter (18.6(3.3) mm to 18.1(2.8) mm) and AAA prevalence (1.32% to 0.69%). The prevalence of small aortas (<17 mm) was 18.5% and that of subaneurysmal aortas (25-29 mm) was 1.1%. Initial aortic diameter showed a non-linear association with mortality (P < 0.001). The 5-year mortality was 3.8% for men with a normal aorta, 5.5% for men with a small aorta, 8.1% for men with a subaneurysmal aorta, and 9.5% for men with an AAA. The incidence of non-smoking men with an AAA remained constant, while a decline in the number of men with a smoking history was observed. Smoking cessation influenced timing of surgery and survival, with a 5-year mortality of 11.1% in current smokers versus 5.6% in non-smokers.
Conclusion: There has been a decline in the prevalence of AAA and subaneurysmal aortas, and a slight rise in men with small aortas. Men with small or aneurysmatic aortas are at 1.5-2.5 times higher risk of mortality at 5 years compared with men with normal diameters. Smoking cessation halts the progression to AAA surgery and is associated with reduced mortality.
© The Author(s) 2025. Published by Oxford University Press on behalf of BJS Foundation Ltd.