Underscreening of Abdominal Aortic Aneurysms

INTRODUCTION: Screening for abdominal aortic aneurysms (AAA) is indicated for aging men with a history of ever-smoking. The accuracy of obtaining a smoking history is unknown, but represents a potential barrier to providing adequate screening. The goal of this study was to determine the accuracy of reporting a smoking history, and to estimate the impact of under-reporting on AAA screening. METHODS: Data were extracted from Public Use files of the National Health Interview Survey (NHIS). Data was collected for men from survey years 1970, 1980, 1990, 1999, and 2009 for a cohort born 1934 - 1944. Proportion of ever-smokers for each survey year was extrapolated to 2009 after adjusting for smoking-related mortality, and was compared with 2009 survey results. RESULTS: A total of 13,392 participants were included in the study, corresponding to men ages 65 – 75 in 2009. Mean survey sample size was 3716 (range 883 – 7194). After adjusting for differences in smoking-related mortality, smoking was under-reported by 6% (65.2% +/- 3.8% vs. 71.2% +/- 1.6%, p<.0001). By age ever-smoking was under-reported by up to 19.7%. Under-reporting was measurable by age 50. An estimated 600,000 men failed to report a smoking history with 30,000 AAA remaining undiagnosed. CONCLUSION: Ever-smoking is under-reported by aging men in the United States. Without accurate reporting of ever-smoking, patients may not qualify for screening under current Medicare guidelines, and smoking-related disease such as AAA will remain under-diagnosed and under-treated.