A prospective study of anemia status, hemoglobin concentration, and mortality in an elderly cohort: The cardiovascular health study

Neil A. Zakai, Ronit Katz, Calvin H Hirsch, Michael G. Shlipak, Paulo H M Chaves, Anne B. Newman, Mary Cushman

Research output: Contribution to journalArticle

301 Citations (Scopus)

Abstract

Background: Anemia is viewed as a negative prognostic factor in the elderly population; its independent impact on survival is unclear. Methods: Baseline hemoglobin quintiles and anemia, as defined by the World Health Organization criteria, were assessed in relation to mortality in the Cardiovascular Health Study, a prospective cohort study with 11.2 years of follow-up of 5888 community-dwelling men and women 65 years or older, enrolled in 1989-1990 or 1992-1993 in 4 US communities. Results: A total of 1205 participants were in the lowest hemoglobin quintile (<13.7 g/dL for men; <12.6 g/dL for women), and 498 (8.5%) were anemic (<13 g/dL for men; <12 g/dL for women). A reverse J-shaped relationship with mortality was observed; age-, sex-, and race-adjusted hazard ratios (95% confidence interval [CI]) in the first and fifth quintiles, compared with the fourth quintile, were 1.42 (95% CI, 1.25-1.62) and 1.24 (95% CI, 1.09-1.42). After multivariate adjustment, these hazard ratios were 1.33 (95% CI, 1.15-1.54) and 1.17 (95% CI, 1.01-1.36). The demographic- and fully-adjusted hazard ratios of anemia for mortality were 1.57 (95% CI, 1.38-1.78) and 1.38 (95% CI, 1.19-1.54). Adjustment for causes and consequences of anemia (renal function, inflammation, or frailty) did not reduce associations. Conclusions: Lower and higher hemoglobin concentrations and anemia by World Health Organization criteria were independently associated with increased mortality. The World Health Organization criteria did not identify risk as well as a lower hemoglobin value. Additional study is needed on the clinically valid definition for and causes of anemia in the elderly and on the increased mortality at the extremes of hemoglobin concentrations.

Original languageEnglish (US)
Pages (from-to)2214-2220
Number of pages7
JournalArchives of Internal Medicine
Volume165
Issue number19
DOIs
StatePublished - Oct 24 2005

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Anemia
Hemoglobins
Prospective Studies
Confidence Intervals
Mortality
Health
Independent Living
Cohort Studies
Demography
Inflammation
Kidney
Survival
Population

ASJC Scopus subject areas

  • Internal Medicine

Cite this

A prospective study of anemia status, hemoglobin concentration, and mortality in an elderly cohort : The cardiovascular health study. / Zakai, Neil A.; Katz, Ronit; Hirsch, Calvin H; Shlipak, Michael G.; Chaves, Paulo H M; Newman, Anne B.; Cushman, Mary.

In: Archives of Internal Medicine, Vol. 165, No. 19, 24.10.2005, p. 2214-2220.

Research output: Contribution to journalArticle

Zakai, Neil A. ; Katz, Ronit ; Hirsch, Calvin H ; Shlipak, Michael G. ; Chaves, Paulo H M ; Newman, Anne B. ; Cushman, Mary. / A prospective study of anemia status, hemoglobin concentration, and mortality in an elderly cohort : The cardiovascular health study. In: Archives of Internal Medicine. 2005 ; Vol. 165, No. 19. pp. 2214-2220.
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abstract = "Background: Anemia is viewed as a negative prognostic factor in the elderly population; its independent impact on survival is unclear. Methods: Baseline hemoglobin quintiles and anemia, as defined by the World Health Organization criteria, were assessed in relation to mortality in the Cardiovascular Health Study, a prospective cohort study with 11.2 years of follow-up of 5888 community-dwelling men and women 65 years or older, enrolled in 1989-1990 or 1992-1993 in 4 US communities. Results: A total of 1205 participants were in the lowest hemoglobin quintile (<13.7 g/dL for men; <12.6 g/dL for women), and 498 (8.5{\%}) were anemic (<13 g/dL for men; <12 g/dL for women). A reverse J-shaped relationship with mortality was observed; age-, sex-, and race-adjusted hazard ratios (95{\%} confidence interval [CI]) in the first and fifth quintiles, compared with the fourth quintile, were 1.42 (95{\%} CI, 1.25-1.62) and 1.24 (95{\%} CI, 1.09-1.42). After multivariate adjustment, these hazard ratios were 1.33 (95{\%} CI, 1.15-1.54) and 1.17 (95{\%} CI, 1.01-1.36). The demographic- and fully-adjusted hazard ratios of anemia for mortality were 1.57 (95{\%} CI, 1.38-1.78) and 1.38 (95{\%} CI, 1.19-1.54). Adjustment for causes and consequences of anemia (renal function, inflammation, or frailty) did not reduce associations. Conclusions: Lower and higher hemoglobin concentrations and anemia by World Health Organization criteria were independently associated with increased mortality. The World Health Organization criteria did not identify risk as well as a lower hemoglobin value. Additional study is needed on the clinically valid definition for and causes of anemia in the elderly and on the increased mortality at the extremes of hemoglobin concentrations.",
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AU - Zakai, Neil A.

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AU - Chaves, Paulo H M

AU - Newman, Anne B.

AU - Cushman, Mary

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AB - Background: Anemia is viewed as a negative prognostic factor in the elderly population; its independent impact on survival is unclear. Methods: Baseline hemoglobin quintiles and anemia, as defined by the World Health Organization criteria, were assessed in relation to mortality in the Cardiovascular Health Study, a prospective cohort study with 11.2 years of follow-up of 5888 community-dwelling men and women 65 years or older, enrolled in 1989-1990 or 1992-1993 in 4 US communities. Results: A total of 1205 participants were in the lowest hemoglobin quintile (<13.7 g/dL for men; <12.6 g/dL for women), and 498 (8.5%) were anemic (<13 g/dL for men; <12 g/dL for women). A reverse J-shaped relationship with mortality was observed; age-, sex-, and race-adjusted hazard ratios (95% confidence interval [CI]) in the first and fifth quintiles, compared with the fourth quintile, were 1.42 (95% CI, 1.25-1.62) and 1.24 (95% CI, 1.09-1.42). After multivariate adjustment, these hazard ratios were 1.33 (95% CI, 1.15-1.54) and 1.17 (95% CI, 1.01-1.36). The demographic- and fully-adjusted hazard ratios of anemia for mortality were 1.57 (95% CI, 1.38-1.78) and 1.38 (95% CI, 1.19-1.54). Adjustment for causes and consequences of anemia (renal function, inflammation, or frailty) did not reduce associations. Conclusions: Lower and higher hemoglobin concentrations and anemia by World Health Organization criteria were independently associated with increased mortality. The World Health Organization criteria did not identify risk as well as a lower hemoglobin value. Additional study is needed on the clinically valid definition for and causes of anemia in the elderly and on the increased mortality at the extremes of hemoglobin concentrations.

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