Late-Life Anemia Affects Morbidity and Mortality

December 17, 2003

Dec. 17, 2003 (San Diego) — Healthcare professionals should regularly screen elderly patients for anemia, suggest researchers, who found that late-life anemia is associated with important clinical health outcomes.

Speaking here at the American Society of Hematology 45th annual meeting, Brenda W. Penninx, PhD, from Wake Forest University School of Medicine in Winston-Salem, North Carolina, said that elderly persons with anemia are at 27% increased risk of hospitalization and 61% increased risk of death compared with those without the condition.

The large community-based study used data from three communities of the Established Populations for Epidemiologic Studies of the Elderly, a National Institute on Aging–sponsored study. Hemoglobin (Hb) levels were measured in 3,607 subjects older than 70 years, with anemia defined as Hb levels less than 12 g/dL in women and less than 13 g/dL in men.

Data on mortality and hospital admissions for the patients during a four-year period were obtained from death records and the Health Care Financing Administration Medicare database.

Anemia was identified in 12.5% of the patients. During the four-year follow-up period, 37% of those with anemia died compared with 22.1% of those without the condition (P < .001). In addition, 65.9% of anemic patients were hospitalized vs. 54.6% of those without anemia (P < .001). Anemic patients also spent more days in the hospital: 25 days compared with 13.7 days for those without the condition.

Dr. Penninx told a press conference that even after exclusion of patients with baseline presence of heart disease, diabetes, stroke, cancer, infectious disease, lung disease, and kidney disease, anemia remained significantly associated with increased risks of mortality and hospitalization.

After adjustment for demographics and baseline disease, anemia was associated with a 61% increased risk of mortality (95% confidence interval [CI], 1.34 - 1.93) and a 27% increased risk of hospitalization (95% CI, 1.12 - 1.45).

Conversely, after adjustment for covariates, patients with higher Hb levels were significantly less likely to die (P < .001) or be hospitalized (P < .001), Dr. Pennix said.

Compared with patients with an Hb level 1 to 2 g/dL above the anemia cut-off, those with Hb levels 0 to 1 g/dL or 1 g/dL below the anemia cut-off were at 70% and 99% increased risk of death, respectively. Of note, Dr. Penninx said was that even patients with an Hb level of 0 to 1 g/dL above the anemia cut-off were at 33% increased risk of death (95% CI, 1.10 - 1.62).

As for hospitalizations, patients with Hb levels of 0 to 1 g/dL or 1 g/dL below the anemia cut-off had an increased risk of 18% (95% CI, 1.00 - 1.40) and 54% (95% CI, 1.26 - 1.89), respectively, compared with patients with Hb levels 1 to 2 g/dL above the anemia cut-off.

Stanley Schrier, MD, president-elect of the American Society of Hematology and an active emeritus professor of medicine in the division of hematology at Stanford University in California, said that findings point to the adverse effect of anemia on morbidity and mortality.

"Anemia is not simply a quality-of-life disease," Dr. Schrier said. "Regular testing and treatment of anemia can significantly impact clinical outcomes."

ASH 45th Annual Meeting: Abstract 881. Presented Dec. 9, 2003.

Reviewed by Gary D. Vogin, MD

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