A Population-Based Study of Hemoglobin, Race, and Mortality in Elderly Persons

Dong, XinQi; Leon, Carlos Mendes de; Artz, Andrew S.; Tang, Yuxiao; Shah, Raj J.; Evans, Denis A.

doi:10.1093/gerona/63.8.873

Cited by 69 publications

(50 citation statements)

References 22 publications

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“…4,9,10 It has been suggested that anemia might be masked in some older adults taking diuretics, which can decrease plasma volume, potentially explaining the low-normal hemoglobin concentration to mortality association.…”

Section: Mortality and Hospitalizationmentioning

confidence: 99%

“…[3][4][5] Low-normal hemoglobin concentrations have also been shown to be associated with increased mortality, [5][6][7][8] although this finding is not consistent across studies and depends on the definition of low-normal and the comparison group as well as race/ethnicity and comorbidity. 4,9,10 It has been suggested that anemia might be masked in some older adults taking diuretics, which can decrease plasma volume, potentially explaining the low-normal hemoglobin concentration to mortality association. 11 Alternatively, it is probable that some older adults with low-normal hemoglobin concentrations are more likely to eventually go on to become anemic, potentially increasing their risk of adverse events.…”

Section: Mortality and Hospitalizationmentioning

confidence: 99%

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Prognostic implications of anemia in older adults

Patel¹,

Guralnik²

2009

Haematologica

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A nemia is a common condition among communitydwelling older adults, with prevalence estimates ranging from 9-18% in men and 8-13% in women.1 In those aged 85 years and older -a rapidly growing segment of the world's population -the prevalence of anemia exceeds 20%.2 Importantly, however, less than 1% of community-dwelling older adults have a hemoglobin concentration below 10 g/dL and, therefore, the majority of cases of anemia are mild.2 In contrast, anemia is more severe in institutionalized settings, such as nursing homes, in which the prevalence of anemia ranges from 48-63% in older residents.1 Nonetheless, numerous studies over the past decade have shown that anemia is an independent predictor of a variety of adverse outcomes in both community-dwelling and institutionalized older adults. While evidence continues to accrue suggesting that anemia initiates or exacerbates functional decline, it remains unresolved whether anemia is a marker or a cause of poor prognosis in older adults. Mortality and hospitalizationMortality risk is significantly higher in older anemic adults than in the non-anemic elderly. This association was observed in several major cohort studies and remains significant even after excluding older adults with comorbid conditions (e.g., cardiovascular disease, cancer, kidney disease).3-5 Low-normal hemoglobin concentrations have also been shown to be associated with increased mortality, 5-8 although this finding is not consistent across studies and depends on the definition of low-normal and the comparison group as well as race/ethnicity and comorbidity. 4,9,10 It has been suggested that anemia might be masked in some older adults taking diuretics, which can decrease plasma volume, potentially explaining the low-normal hemoglobin concentration to mortality association. 11Alternatively, it is probable that some older adults with low-normal hemoglobin concentrations are more likely to eventually go on to become anemic, potentially increasing their risk of adverse events. Indeed, a recent study of heart failure patients showed that those who had persistent anemia or developed new onset anemia over a 6-month period were more likely to die than patients who remained non-anemic.12 Importantly, patients whose anemia resolved within 6 months did not have increased mortality, but it was unclear what role treatment played in the resolution of anemia. 12In this issue of the journal, Riva and colleagues reported the risk of hospitalization and death by anemia status in Italian adults aged 65-84 living in Biella, Piedmont.13 These investigators were particularly interested in the effects of mild anemia, defined as a hemoglobin concentration between 10.0 and 11.9 g/dL in women and 10.0 and 12.9 g/dL in men. Consistent with other population-based studies, less than 1% (31/4,501) of the study participants had a hemoglobin concentration below 10 g/dL. After adjusting for potential confounding factors, over the 3-3.5 year follow-up period there was a 32% increased risk of hospitalization and a nearly two-fold i...

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Section: Mortality and Hospitalizationmentioning

confidence: 99%

Section: Mortality and Hospitalizationmentioning

confidence: 99%

Prognostic implications of anemia in older adults

Patel¹,

Guralnik²

2009

Haematologica

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“…Half of the people admitted from their homes do not return there immediately after discharge [5,6]. Recent studies have suggested that anaemia is associated with worse outcomes in the frail and elderly [7,8]. However, the assessment and definitions of anaemia vary as do the outcomes that are reported [9].…”

Section: Introductionmentioning

confidence: 99%

A systematic review of pre-operative anaemia and blood transfusion in patients with fractured hips

2015

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SummaryWe systematically reviewed the observational associations of anaemia with outcomes and the effects of interventions to increase haemoglobin concentrations following hip fracture in older people. Anaemia on hospital admission was associated with increased mortality, relative risk 1.64 (95% CI 1.47-1.82), p < 0.0001. After adjustment for co-morbidities, the association of anaemia with increased mortality remained in four of eight observational studies. There was no association of postoperative transfusion with mortality after adjusting for covariates. Transfusion at 80 g.l À1 vs 100 g.l À1 increased acute myocardial infarction, relative risk 1.67 (95% CI 1.01-2.77), p = 0.05. Transfusion threshold was not associated with differences in other outcomes. There were insufficient high-quality studies to inform pre-operative blood transfusion or the use of peri-operative iron or erythropoietin. Studies for most interventions recruited too few participants to determine effects on infections, mortality or function.

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“…Estudos conduzidos em populações idosas nos Estados Unidos, Canadá e em alguns países europeus evidenciaram maior risco de morte entre aqueles com anemia, independentemente de outros fatores relevantes 5,9,18,19,20,21,22 . Além disso, baixos níveis de Hb, independente do diagnóstico de anemia, também apresentaram associação significativa com mortalidade em algumas populações idosas 18,19,21,23 .…”

Section: Introductionunclassified

Anemia e nível de hemoglobina como fatores prognósticos da mortalidade entre idosos residentes na comunidade: evidências da Coorte de Idosos de Bambuí, Minas Gerais, Brasil

et al. 2013

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O objetivo deste trabalho foi examinar a influência de baixos níveis de hemoglobina (Hb) e anemia na mortalidade entre idosos ao longo de dez anos de seguimento (1997 a 2007). Entre os 1.742 idosos participantes da linha de base da coorte de Bambuí, Minas Gerais, Brasil, 1.322 (82,3%) foram acompanhados pelo tempo médio de 8,9 anos. A probabilidade de sobrevida foi estimada pelo método de Kaplan-Meier e o modelo de riscos proporcionais de Cox foi utilizado, estimando-se os hazard ratios (HR) e intervalos de 95% de confiança (IC95%), considerando-se os potenciais fatores de confusão. Idosos anêmicos e com baixos níveis de Hb (primeiro tercil) apresentaram maior risco de óbito (HR = 2,63; IC95%: 1,83-3,76 e HR = 1,38; IC95%: 1,07-1,79, respectivamente) comparados aos não anêmicos e aos de maior nível de Hb. Os resultados demonstram que a ocorrência de anemia e/ou baixos níveis de Hb (independente do diagnóstico de anemia) devem ser interpretados e tratados como determinante independente da mortalidade nessa população idosa.

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A Population-Based Study of Hemoglobin, Race, and Mortality in Elderly Persons

Abstract: Both anemia by WHO criteria and mild reductions in Hb were related to increased risk of mortality in older blacks and whites.

Cited by 69 publications

References 22 publications

Prognostic implications of anemia in older adults

Prognostic implications of anemia in older adults

A systematic review of pre-operative anaemia and blood transfusion in patients with fractured hips

Anemia e nível de hemoglobina como fatores prognósticos da mortalidade entre idosos residentes na comunidade: evidências da Coorte de Idosos de Bambuí, Minas Gerais, Brasil

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