Smoking, sex, risk factors and abdominal aortic aneurysms: a prospective study of 18 782 persons aged above 65 years in the Southern Community Cohort Study
- 6 January 2015
- journal article
- other topics
- Published by BMJ in Journal of Epidemiology and Community Health
- Vol. 69 (5), 481-488
- https://doi.org/10.1136/jech-2014-204920
Abstract
Background Abdominal aortic aneurysm (AAA) is a leading cause of death in the USA. We evaluated the incidence and predictors of AAA in a prospectively followed cohort. Methods We calculated age-adjusted AAA incidence rates (IR) among 18 782 participants aged ≥65 years in the Southern Community Cohort Study who received Medicare coverage from 1999–2012, and assessed predictors of AAA using multivariable Cox proportional hazards models, overall and stratified by sex, adjusting for demographic, lifestyle, socioeconomic, medical and other factors. HRs and 95% CIs were calculated for AAA in relation to factors ascertained at enrolment. Results Over a median follow-up of 4.94 years, 281 cases were identified. Annual IR was 153/100 000, 401, 354 and 174 among blacks, whites, men and women, respectively. AAA risk was lower among women (HR 0.48, 95% CI 0.36 to 0.65) and blacks (HR 0.51, 95% CI 0.37 to 0.69). Smoking was the strongest risk factor (former: HR 1.91, 95% CI 1.27 to 2.87; current: HR 5.55, 95% CI 3.67 to 8.40), and pronounced in women (former: HR 3.4, 95% CI 1.83 to 6.31; current: HR 9.17, 95% CI 4.95 to 17). A history of hypertension (HR 1.44, 95% CI 1.04 to 2.01) and myocardial infarction or coronary artery bypass surgery (HR 1.9, 95% CI 1.37 to 2.63) was negatively associated, whereas a body mass index ≥25 kg/m2 (HR 0.72; 95% CI 0.53 to 0.98) was protective. College education (HR 0.6, 95% CI 0.37 to 0.97) and black race (HR 0.44, 95% CI 0.28 to 0.67) were protective among men. Conclusions Smoking is a major risk factor for incident AAA, with a strong and similar association between men and women. Further studies are needed to evaluate benefits of ultrasound screening for AAA among women smokers.Keywords
This publication has 39 references indexed in Scilit:
- The Rise and Fall of Abdominal Aortic AneurysmCirculation, 2011
- Low Prevalence of Abdominal Aortic Aneurysm Among 65-Year-Old Swedish Men Indicates a Change in the Epidemiology of the DiseaseCell Metabolism, 2011
- Analysis of risk factors for abdominal aortic aneurysm in a cohort of more than 3 million individualsJournal of Vascular Surgery, 2010
- The Southern Community Cohort Study: Investigating Health DisparitiesJournal of Health Care for the Poor and Underserved, 2010
- Abdominal aortic aneurysm events in the women's health initiative: cohort studyBMJ, 2008
- Risk Factors for Abdominal Aortic Aneurysm and the Influence of Social DeprivationAngiology, 2008
- Traditional and Novel Risk Factors for Clinically Diagnosed Abdominal Aortic Aneurysm: The Kaiser Multiphasic Health Checkup Cohort StudyAnnals of Epidemiology, 2007
- Middle Age Cardiovascular Risk Factors and Abdominal Aortic Aneurysm in Older AgeHypertension, 2003
- Randomized clinical trial of screening for abdominal aortic aneurysm in womenBritish Journal of Surgery, 2002
- The Incidence of Small Abdominal Aortic Aneurysms and the Change in Normal Infrarenal Aortic Diameter: Implications for ScreeningEuropean Journal of Vascular and Endovascular Surgery, 2001