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Original research
Temporal trends in mortality of aortic dissection and rupture in the UK, Japan, the USA and Canada
  1. Makoto Hibino1,2,
  2. Subodh Verma2,3,
  3. Craig M Jarret4,
  4. Junichi Shimamura1,
  5. Raj Verma5,
  6. Hiromi Hibino6,
  7. Cristian R Baeza4,
  8. Dagfinn Aune7,8,
  9. Bobby Yanagawa2,3,
  10. Akihiko Usui9,
  11. Christoph A Nienaber10,11,
  12. Marc P Pelletier4
  1. 1 Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, Georgia, USA
  2. 2 Division of Cardiac Surgery, St. Michael’s Hospital of Unity Health Toronto, Toronto, Ontario, Canada
  3. 3 Department of Surgery, University of Toronto, Toronto, Ontario, Canada
  4. 4 Division of Cardiac Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
  5. 5 Royal College of Surgeon in Ireland, Dublin, Ireland
  6. 6 Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, UK
  7. 7 Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
  8. 8 Department of Nutrition, Oslo New University College, Oslo, Norway
  9. 9 Department of Cardiac Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
  10. 10 Cardiology and Aortic Centre, Royal Brompton and Harefield Hospitals, Guy's and St. Thomas' NHS Foundation Trust, London, UK
  11. 11 National Heart and Lung Institute, Faculty of Medicine, Imperial College London, London, UK
  1. Correspondence to Dr Makoto Hibino, Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, Georgia, USA; mhibino-ngy{at}umin.org

Abstract

Objective Aortic dissection and aortic aneurysm rupture are aortic emergencies and their clinical outcomes have improved over the past two decades; however, whether this has translated into lower mortality across countries remains an open question. The purpose of this study was to compare mortality trends from aortic dissection and rupture between the UK, Japan, the USA and Canada.

Methods We analysed the WHO mortality database to determine trends in mortality from aortic dissection and rupture in four countries from 2000 to 2019. Age-standardised mortality rates per 100 000 persons were calculated, and annual percentage change was estimated using joinpoint regression.

Results Age-standardised mortality rates per 100 000 persons from aortic dissection and rupture in 2019 were 1.04 and 1.80 in the UK, 2.66 and 1.16 in Japan, 0.76 and 0.52 in the USA, and 0.67 and 0.81 in Canada, respectively. There was significantly decreasing trends in age-standardised mortality from aortic rupture in all four countries and decreasing trends in age-standardised mortality from aortic dissection in the UK over the study period. There was significantly increasing trends in mortality from aortic dissection in Japan over the study period. Joinpoint regression identified significant changes in the aortic dissection trends from decreasing to increasing in the USA from 2010 and Canada from 2012. In sensitivity analyses stratified by sex, similar trends were observed.

Conclusions Trends in mortality from aortic rupture are decreasing; however, mortality from aortic dissection is increasing in Japan, the USA and Canada. Further study to explain these trends is warranted.

  • Aneurysm, Dissecting
  • Aortic Aneurysm

Data availability statement

Data are available in a public, open access repository.

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Data availability statement

Data are available in a public, open access repository.

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Footnotes

  • Twitter @HibinoMDMPH, @SubodhVermaMD, @ShimamuraMD, @BobbyYanagawa, @MarcPPelletier

  • Contributors MH contributed to the conception and design, analysis and interpretation of data, as well as manuscript preparation and revision. SV, RV, CRB, DA, BY, AU, CAN and MPP contributed to interpretation of the data and manuscript revision. HH contributed to the conception. CMJ and JS contributed to manuscript preparation. MH is responsible for the overall content of the manuscript as guarantor. All authors have read and approved the final manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests All authors report no relevant conflicts of interest.

  • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting or dissemination plans of this research.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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