OBJECTIVES: To estimate the number of prevalent cases of abdominal aortic aneurysm (AAA) and deaths attributable to AAA in five major European Union (5EU) markets: France, Germany, Italy, Spain, and the United Kingdom (UK). METHODS: We used disease modeling software, DisMod II (World Health Organization), to assess AAA burden via a multi-state life table where differential equations define relationships between incidence, prevalence, and disease-specific mortality. Market-specific input data included age- and sex-specific population structure, age- and sex-specific all-cause mortality, and cubic spline interpolation of size- and sex-specific AAA prevalence. Other input data consisted of relative risk (RR) estimates of death for persons with AAA compared with persons without AAA, adjusted for age, ethnicity, height, weight, smoking, and cardiovascular disease history.  RESULTS: We estimated 2,484,058 prevalent cases in the 5EU in 2013 (90% CI: 2,282,702–2,638,106), resulting in 48,805 deaths attributable to AAA (90% CI: 39,924–54,291). In the combined 5EU, females accounted for 20.2% of prevalent cases and 43.2% of deaths. France had the lowest number of prevalent cases (581.8 per 100,000 population) and deaths (11.0 per 100,000 population) among the 5EU markets, while Italy had the highest number of prevalent cases (1,103.7 per 100,000 population) and deaths (22.3 per 100,000 population). The number of deaths attributable to AAA in Italy represented 28.0% of the 5EU total, despite Italy accounting for only 19.3% of the 5EU population in 2013.  CONCLUSIONS: Our study reveals that the burden of AAA among the 5EU markets is most severe in Italy, which accounted for the highest number of both prevalent cases and deaths attributable to AAA in the 5EU. Throughout the 5EU, females accounted for a disproportionately high percentage of deaths despite constituting a low percentage of prevalent cases. Consequently, current screening guidelines should target both sexes, rather than males only.