Reasons for non-participation in population-based abdominal aortic aneurysm screening

BackgroundA population-based screening programme for abdominal aortic aneurysm (AAA) started in 2010 in Stockholm County, Sweden. This present study used individual data from Sweden's extensive healthcare registries to identify the reasons for non-participation in the AAA screening programme. MethodsAll 65-year-old men in Stockholm are invited to screening for AAA; this study included all men invited from July 2010 to July 2012. Participants and non-participants were compared for socioeconomic factors, travel distance to the examination centre and healthcare use. The influence of these factors on participation was analysed using univariable and multivariable logistic regression models. ResultsThe participation rate for AAA screening was 776 per cent (18876 of 24319 men invited). The prevalence of AAA (aortic diameter more than 29cm) among participants was 14 per cent. The most important reasons for non-participation in the multivariable regression analyses were: recent immigration (within 5years) (odds ratio (OR) 325, 95 per cent confidence interval 194 to 547), low income (OR 276, 246 to 310), marital status single or divorced (OR 223, 208 to 239), low level of education (OR 128, 116 to 140) and long travel distance (OR 123, 110 to 137). Non-participants had a higher incidence of stroke (45 versus 28 per cent; P<0001) and chronic pulmonary disease (29 versus 13 per cent; P<0001). Daily smoking was more common in residential areas where the participation rate for AAA screening was low. ConclusionEfforts to improve participation in AAA screening should target the groups with low income, a low level of education and immigrants. The higher morbidity in the non-participant group, together with a higher rate of smoking, make it probable that this group also has a high risk of AAA. Attendance could be improved