How Common Is Death from a Ruptured Abdominal Aortic Aneurysm?
If you are invited for abdominal aortic aneurysm (AAA) screening, you may be told that a ruptured AAA is usually fatal.
That is true. But it raises another question:
How likely are you to suffer a ruptured AAA in the first place?
One way of putting the risk into context is to look at how many deaths among older men are actually caused by one.
How common is death from a ruptured AAA?
In England in 2023, ruptured AAA accounted for 0.55% of all deaths among men aged 65 and over.
Put another way:
Out of every 1,000 deaths among men aged 65 and over, about 5 or 6 were caused by a ruptured AAA. About 994 or 995 were from other causes.
It used to be more common
Deaths from ruptured AAA have fallen substantially.
In 2001, ruptured AAA accounted for 1.46% of deaths among men aged 65 and over in England and Wales. In 2005, 2,622 men died from one, representing 1.38% of deaths among men in that age group.
By 2012, the proportion had fallen to 1.09%. From 2013, the review reports the countries separately.
| Year | Area | Deaths from ruptured AAA |
|---|---|---|
| 2001 | England & Wales | 1.46% |
| 2005 | England & Wales | 1.38% |
| 2010 | England & Wales | 1.24% |
| 2012 | England & Wales | 1.09% |
| 2013 | England | 1.01% |
| 2018 | England | 0.75% |
| 2023 | England | 0.55% |
AAA screening began rolling out across the UK from 2009 and was fully operational across all four UK nations by 2013.
The decline had therefore begun well before nationwide screening and continued afterwards. These figures alone cannot tell us how much, if any, of the later decline was caused by screening.
The long-term decline in smoking is considered an important explanation for the fall in AAA. Other changes in health and healthcare may also have contributed.
What about the claim that 85 out of 100 people die?
A review cited by the UK National Screening Committee estimated that about 82% of people who suffered a ruptured AAA died.
So the familiar figure that around 85 out of 100 people die if an AAA ruptures is broadly consistent with the evidence.
But it is important to distinguish two things:
“Around 85 out of 100 people die if an AAA ruptures” tells you how dangerous a rupture is. It doesn't tell you how likely you are to suffer a rupture in the first place.
Why might you have seen a higher figure?
Some current government information for health professionals still says that around 3,000 men aged 65 and over die each year from ruptured AAA in England and Wales, accounting for around 1.7% of deaths among men in this age group.
The government's newer data show a substantially lower contemporary figure: 0.55% of deaths among men aged 65 and over in England in 2023.
Even in 2005, the newer review records 2,622 deaths and 1.38%.
What does this tell us about screening?
Only part of the story.
It tells us how common the outcome that screening is intended to help prevent has become. It does not tell us how much, if at all, screening reduces that risk, whether the benefits outweigh the downsides, or how your own risk compares with the average.
Those are separate questions.