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Anemia in Old Age Is Associated With Increased Mortality and Hospitalization

¹ EMGO Institute and Department of Psychiatry, VU University School of Medicine, Amsterdam, The Netherlands.
² Department of Aging and Geriatric Research, University of Florida, Gainesville.
³ Ortho Biotech Products, L.P., Bridgewater, New Jersey.
⁴ Laboratory of Epidemiology, Demography, and Biometry, National Institute on Aging, Bethesda, Maryland.

Address correspondence to Brenda Penninx, PhD, EMGO Institute/Department of Psychiatry, VU University Medical Center, Valeriusplein 9, 1075 BG Amsterdam, The Netherlands. E-mail: b.penninx{at}vumc.nl or brendap{at}ggzba.nl

Background. Anemia is common in old age and has been shown to affect older persons' physical function. To more fully understand the detrimental health effects of anemia, we examined the relationship of anemia with death and hospitalization outcomes in a large community-based sample of older persons.

Methods. Data are from 3607 persons, aged 71 years or older, participating in the National Institute on Aging (NIA)-sponsored Established Populations for Epidemiologic Studies of the Elderly (EPESE) study. Anemia was defined according to World Health Organization (WHO) criteria as a hemoglobin concentration below 12 g/dL in women and below 13 g/dL in men. Data on subsequent mortality and hospital admissions over 4 years were obtained from death records and the Medicare database.

Results. Anemia was present in 451 of the 3607 (12.5%) participants. During the follow-up period, anemic persons were more likely to die than were nonanemic persons (37.0% vs 22.1%, p <.001). Also, anemic persons were more often hospitalized (65.9% vs 54.6%, p <.001) and spent more days in hospital (25.0 vs 13.7, p <.001). After adjustment for demographics and baseline comorbidities, anemia significantly predicted subsequent mortality and hospitalization (relative risk = 1.61, 95% confidence interval, 1.34–1.93; and relative risk = 1.27, 95% confidence interval, 1.12–1.45, respectively). After excluding persons with prevalent diseases at baseline, anemia remained significantly associated with increased risks of mortality and hospitalization. A higher hemoglobin level was significantly associated with lower risks of mortality and hospitalization (p for trend <.001 for both).

Conclusions. These findings indicate that late-life anemia characterizes persons at risk for important clinical health outcomes, and demonstrate the importance of clinical awareness of anemia even if the person is without apparent clinical disease.