Title: Underutilization of Guideline-based Abdominal Aortic Aneurysm Screening in an Academic Health System
Country: United States
Age: Adult Only
Population: Multiple Groups
Care Setting: Outpatient Ambulatory and Primary Care
Clinical Setting: Abdominal Aortic Aneurysm Screening
Data Level: Single Institution
Data Type: EHR
Data Source: Local data
Conclusion: Disparities In Some Minority Groups
Health OutComes Reported: No
Free Text Conclusion: Black, Mixed Race, and American Indian/ Alaskan Native patients had lower odds of receiving AAA screening with 2 year follow-up. Asian patients had higher odds.
Abstract: OBJECTIVES: The US Preventive Services Task Force (USPSTF) recommends a 1 time screening for AAA with ultrasonography in men aged 65-75 who have ever smoked. Our objectives were to identify the AAA screening rates in a large academic health system and assess factors associated with receipt of screening. METHODS: Data were extracted from electronic health records from the Duke University Health System and the US Census Bureau. Index screening eligibility date was defined as the 65th birthdate for male patients with a history of smoking. Patients with an index screening eligibility date between January 1, 2016 and December 31, 2018 were included in the study population and followed through December 31, 2019. Screened patients were identified by procedure codes for ultrasonography, CT or MRI. RESULTS: Among 6,682 eligible patients who turned 65 years old between January 1, 2016 and December 31, 2018 with at least 1 year of follow-up, only 463 (6.9%) received AAA screening during the study period. The odds of receiving AAA screening within 1 year of index eligibility were 27% lower for Black patients compared to whites [OR= 0.73, 95% CI (0.58, 0.93)]. Patients who visited a PCP or were diagnosed with hypertension had 75% and 41% greater odds of receiving screening, respectively [OR 1.75, 95% CI(1.36, 2.25)] and [OR 1.41 95% CI (1.11, 1.80)] compared with patients who did not. Among 4,580 men with 2 years of follow-up, AAA screening rate increased to 13.0%. Patients who visited a PCP had 64% greater odds of receiving screening within 2 years of index eligibility compared to those who did not [OR=1.64, 95% CI (1.30, 2.06)]. CONCLUSIONS: Screening for AAA per USPSTF guidelines is under utilized with evidence of a racial disparity. Although PCP visit is the most consistent predictor of screening, provider screening rates are low.