In a nationwide NHIS-based analysis of Koreans aged ≥50 years (2009–2018), the overall incidence of abdominal aortic aneurysm (AAA) increased from 32.33 per 100,000 in 2009 to 46.85 per 100,000 in 2018; in 2018, incidence was 63.40 per 100,000 in men and 32.07 per 100,000 in women. [1]

Using National Health Insurance Review and Assessment Service (HIRA) claims data with AAA treatment codes (2012–2016), the national prevalence of AAA increased from 201 per million population in 2012 to 278 per million in 2016. [2] In the same analysis, the proportion of ruptured AAA among treated AAA decreased from 8.6% (2012) to 7.3% (2016). [2] Annual surgical treatments increased from 1,129 cases (2012) to 1,501 cases (2016), consistent with an increasing treated burden and/or detection. [2]

In a nationwide NHIS-based analysis (2009–2018), all-cause mortality among AAA patients declined over time in both treated and untreated groups, while remaining higher in untreated patients than treated patients. [1] In a nationwide HIRA treatment-code cohort (2012–2016), ruptured AAA represented a minority of treated cases but remained clinically important given its high fatality risk. [2] In a large Korean NHIS-based cohort (2008–2019) comparing endovascular aneurysm repair (EVAR) vs open surgical repair (OSR), perioperative outcomes and long-term survival were assessed in real-world Korean practice. [3]

Across Korean nationwide analyses, AAA burden is higher in men than women. In the NHIS incidence study (≥50 years, 2009–2018), men had higher annual incidences than women throughout the study period (e.g., overall 49.7 vs 26.8 per 100,000 during 2009–2018; 63.40 vs 32.07 per 100,000 in 2018). [1] In the HIRA treatment-code cohort (2012–2016), most treated AAA cases occurred in men, consistent with male predominance in treated AAA. [2]

Age was strongly associated with AAA incidence in Korean nationwide data, with markedly higher incidence among adults aged ≥65 years than those aged <65 years. [1] In 2018, incidence in men aged ≥65 years (141.5 per 100,000) substantially exceeded that in younger men, indicating that older age groups account for a large fraction of AAA burden. [1]

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AAA is commonly classified by anatomic location and clinical presentation. Location-based phenotypes include abdominal aortic aneurysm (AAA) and thoracic aortic aneurysm (TAA), with AAA typically involving the infrarenal abdominal aorta; presentation may be unruptured (asymptomatic or symptomatic) or ruptured. [4][5] Korean nationwide studies operationalize AAA case definitions using ICD-10 diagnosis codes and procedure codes in NHIS/HIRA databases, distinguishing ruptured vs unruptured AAA for epidemiologic estimates. [1-3]

Most AAAs are asymptomatic until discovered incidentally or through imaging for other indications. When symptomatic, patients may report abdominal, back, or flank pain; a ruptured AAA can present with sudden severe pain, hypotension/shock, and high early mortality. [5] Clinical evaluation and urgent imaging are recommended when rupture is suspected. [4][5]

Key risk factors include older age, male sex, smoking, hypertension, and atherosclerotic cardiovascular disease; family history is also relevant. [5] In Korean nationwide data, AAA incidence is higher in older men and increases over time, consistent with these established risk factors in populations without systematic screening. [1] Risk-factor modification (especially smoking cessation and blood pressure control) is recommended as part of comprehensive aortic disease management. [4][5]

Diagnosis is primarily imaging-based. Abdominal ultrasound is commonly used for screening and initial assessment; CT angiography is used for detailed anatomic evaluation and preoperative planning, including aneurysm size, morphology, and involvement of branch vessels. [4][5] Guideline-based measurement and standardized reporting are emphasized because management thresholds depend on accurate maximal diameter assessment. [4][5]

In the HIRA treatment-code cohort (2012–2016), endovascular aneurysm repair (EVAR) comprised a growing share of AAA repairs while the rupture proportion among treated AAA declined. [2] In a Korean NHIS-based nationwide comparative study (2008–2019), EVAR was associated with lower perioperative mortality than OSR, but higher long-term mortality and higher AAA-related reintervention rates and costs, highlighting real-world trade-offs under the Korean medical expense system. [3] Guideline-based indications for elective repair (e.g., by aneurysm size, growth, symptoms, and operative risk) and for management of ruptured AAA guide treatment selection. [5]

Prognosis depends strongly on rupture status and treatment modality. Ruptured AAA is associated with very high short-term mortality, whereas elective repair outcomes are substantially better. [5] In Korean nationwide data, long-term outcomes differ between EVAR and OSR: EVAR shows perioperative advantages but may have higher long-term mortality and reintervention burden compared with OSR. [3] Population-level mortality among diagnosed AAA patients has decreased over time in Korea, suggesting improving management and/or earlier detection. [1]

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[1] An Epidemiologic Study of the Incidence and Mortality of Abdominal Aortic Aneurysms in Koreans Aged ≥50 Years from 2009 to 2018 Based on a National Database. J Clin Med. 2023;12(13):4319 [2] Nationwide Epidemiologic Study of Abdominal Aortic Aneurysms in Korea: A Cross-Sectional Study Using National Health Insurance Review and Assessment Service Data. Vasc Specialist Int. 2019;35(4):193-201 [3] Treatment of abdominal aortic aneurysms in Korea: a nationwide study. Ann Surg Treat Res. 2023;105(1):37-46 [4] 2022 ACC/AHA Guideline for the Diagnosis and Management of Aortic Disease: A Report of the American Heart Association/American College of Cardiology Joint Committee on Clinical Practice Guidelines. Circulation. 2022;146(24):e334-e482 [5] The Society for Vascular Surgery practice guidelines on the care of patients with an abdominal aortic aneurysm. J Vasc Surg. 2018;67(1):2-77.e2