Association between anemia in older adults and adverse clinical outcome based on large prospective studies
| Study name . | Study population . | Reference . | Finding/comments . |
|---|---|---|---|
| NHANES III Study (National Health & Nutrition Examination Survey) | Noninstitutionalized US population ≥65 y from third NHANES (1988-1994) | 11 | Significant negative impact of anemia on OS (RR of 1.8; P < .001). Differential impact of subtypes of anemia: nutritional (RR of 2.34, P < .0001), CKD (1.70, P < .0001), chronic inflammation (1.48, P < .0001), UA (1.26, P < .01). |
| Health and Anemia Study (Salute e Anemia) | Observational study of all 65- to 84-y-old residents (N = 10 110); Biella, Piedmont, Italy | 19 | Mild-grade anemia (F: 10.0-11.9 g/dL; M: 10.0-12.9 g/dL) independently associated with poorer cognition, function, mood, and QoL (uni- and multivariate analysis adjusted for comorbidities, age, and sex). |
| InCHIANTI (Invecchiare in Chianti, “Aging in the Chianti Area”) | Population-based study; Tuscany region, Italy | 23 | Anemia is associated with disability, poorer physical performance, and lower muscle strength (even in adjusted analyses including comorbidities, renal function, and inflammatory markers). |
| 22 | Anemia is associated with a significantly higher risk of depressive symptoms after adjusting with potential confounders (OR = 1.93; 95% confidence interval [CI], 1.19-3.13). | ||
| Leiden 85-Plus Study | Population-based prospective study; Leiden, The Netherlands | 24 | Prevalent anemia and incident anemia were both associated with an increased mortality, even after adjustment (hazard ratio [HR] for prevalent anemia, 1.41; 95% CI, 1.13-1.76; HR for incident anemia, 2.08; 95% CI, 1.60-2.70). |
| Health, Aging, and Body Composition Study (Health ABC) | Prospective cohort 3075 community-dwelling white and black older adults 70-79 y from Memphis, Tennessee, or Pittsburgh, Pennsylvania; beginning in 1997 | 20 | Baseline anemia had an increased risk for dementia (23% vs 17%; HR, 1.64; 95% CI, 1.30-2.07) in unadjusted analysis. Remains significant in adjusted analyses (for comorbidities, MCV, renal function, CRP, etc). |
| Cardiovascular Health Study | Prospective cohort study with 11.2 y of follow-up of 5888 community-dwelling men and women 65 y or older, enrolled in 1989-1990 or 1992-1993 in 4 US communities | 14 | Anemia as per WHO criteria was independently associated with increased mortality. After multivariate adjustment, HR for mortality was 1.33 (95% CI, 1.15-1.54). |
| 31 | Hb decline was associated with subsequently poorer cognitive function in men and anemia development with poorer cognitive function in women. | ||
| Both anemia development (HR, 1.39; 95% CI, 1.15-1.69) and Hb decline (HR, 1.11; 95% CI, 1.04-1.18 per 1 g/dL decrease) predicted subsequent mortality. |
| Study name . | Study population . | Reference . | Finding/comments . |
|---|---|---|---|
| NHANES III Study (National Health & Nutrition Examination Survey) | Noninstitutionalized US population ≥65 y from third NHANES (1988-1994) | 11 | Significant negative impact of anemia on OS (RR of 1.8; P < .001). Differential impact of subtypes of anemia: nutritional (RR of 2.34, P < .0001), CKD (1.70, P < .0001), chronic inflammation (1.48, P < .0001), UA (1.26, P < .01). |
| Health and Anemia Study (Salute e Anemia) | Observational study of all 65- to 84-y-old residents (N = 10 110); Biella, Piedmont, Italy | 19 | Mild-grade anemia (F: 10.0-11.9 g/dL; M: 10.0-12.9 g/dL) independently associated with poorer cognition, function, mood, and QoL (uni- and multivariate analysis adjusted for comorbidities, age, and sex). |
| InCHIANTI (Invecchiare in Chianti, “Aging in the Chianti Area”) | Population-based study; Tuscany region, Italy | 23 | Anemia is associated with disability, poorer physical performance, and lower muscle strength (even in adjusted analyses including comorbidities, renal function, and inflammatory markers). |
| 22 | Anemia is associated with a significantly higher risk of depressive symptoms after adjusting with potential confounders (OR = 1.93; 95% confidence interval [CI], 1.19-3.13). | ||
| Leiden 85-Plus Study | Population-based prospective study; Leiden, The Netherlands | 24 | Prevalent anemia and incident anemia were both associated with an increased mortality, even after adjustment (hazard ratio [HR] for prevalent anemia, 1.41; 95% CI, 1.13-1.76; HR for incident anemia, 2.08; 95% CI, 1.60-2.70). |
| Health, Aging, and Body Composition Study (Health ABC) | Prospective cohort 3075 community-dwelling white and black older adults 70-79 y from Memphis, Tennessee, or Pittsburgh, Pennsylvania; beginning in 1997 | 20 | Baseline anemia had an increased risk for dementia (23% vs 17%; HR, 1.64; 95% CI, 1.30-2.07) in unadjusted analysis. Remains significant in adjusted analyses (for comorbidities, MCV, renal function, CRP, etc). |
| Cardiovascular Health Study | Prospective cohort study with 11.2 y of follow-up of 5888 community-dwelling men and women 65 y or older, enrolled in 1989-1990 or 1992-1993 in 4 US communities | 14 | Anemia as per WHO criteria was independently associated with increased mortality. After multivariate adjustment, HR for mortality was 1.33 (95% CI, 1.15-1.54). |
| 31 | Hb decline was associated with subsequently poorer cognitive function in men and anemia development with poorer cognitive function in women. | ||
| Both anemia development (HR, 1.39; 95% CI, 1.15-1.69) and Hb decline (HR, 1.11; 95% CI, 1.04-1.18 per 1 g/dL decrease) predicted subsequent mortality. |
CRP, C-reactive protein; F, female; M, male; MCV, mean corpuscular volume; OR, odds ratio; OS, overall survival; RR, relative risk.