# Socioeconomic Inequities in Abdominal Aortic Aneurysm Screening Uptake Among Women: A Narrative Review

## TL;DR

This paper reviews how socioeconomic factors contribute to lower abdominal aortic aneurysm screening rates among women in the U.S., highlighting the need for equitable screening policies.

## Contribution

The study synthesizes evidence on how socioeconomic determinants interact with sex to affect AAA screening disparities in women.

## Key findings

- Lower income, education, and health literacy are linked to reduced AAA screening uptake among women.
- Rural residence and race/ethnicity also correlate with delayed AAA diagnosis in women.
- Socioeconomic factors appear to interact with female sex, contributing to higher rupture risk.

## Abstract

Abdominal aortic aneurysm (AAA) is a life-threatening vascular condition with higher rupture risk and poorer surgical outcomes in women compared to men. U.S. screening programs predominantly target men, potentially contributing to underdiagnosis among high-risk women. Socioeconomic factors may influence disparities in AAA screening participation.

The aim of this narrative review is to synthesize evidence on socioeconomic determinants influencing AAA screening uptake among women in the United States and to explore potential equity-centered strategies.

A narrative review was conducted using PubMed, MEDLINE, Scopus, and Google Scholar for U.S.-based studies published between January 1990 and August 2025. Search terms included “abdominal aortic aneurysm,” “AAA screening,” “women,” “socioeconomic status,” “income,” “education,” “health disparities,” and “screening uptake.” Eligible studies included observational studies, cohort studies, retrospective analyses, policy reviews, and meta-analyses reporting AAA outcomes stratified by sex and at least one socioeconomic factor. Two reviewers independently screened studies and extracted data on study characteristics, AAA outcomes, and socioeconomic determinants. Findings were synthesized narratively.

Thirty-two studies met inclusion criteria. Evidence suggests that women experience lower AAA screening rates, influenced by guideline exclusions and intersecting socioeconomic factors. Lower income, limited education and health literacy, underinsurance, rural residence, and race/ethnicity were consistently associated with reduced screening uptake and delayed diagnosis. While the strength and consistency of associations varied across studies, socioeconomic determinants appeared to interact with female sex, potentially contributing to later-stage presentation and higher rupture risk.

Socioeconomic inequities are associated with disparities in AAA screening among women. Integrating socioeconomic factors into screening policy and clinical practice, alongside targeted interventions, may help improve equity in detection. Future research should prioritize sex- and socioeconomic status (SES)-disaggregated data and evaluate the effectiveness of interventions designed to enhance screening access for high-risk women.