Clinical research study
Impact of Anemia on Mortality, Cognition, and Function in Community-Dwelling Elderly

https://doi.org/10.1016/j.amjmed.2005.08.027Get rights and content

Abstract

Purpose

To explore the impact of varying hemoglobin levels on mortality, function, and cognition in a representative population of older persons.

Methods

Participants in this prospective cohort study included 1 744 men and women, aged 71 years or older, from a random household sample living in Durham and surrounding counties in North Carolina. Hemoglobin levels were obtained from participants at baseline in 1992. Functional status was measured at the 4-year follow-up interview using Katz and instrumental activities of daily living. Cognition was measured using the Short Portable Mental Status Questionnaire (SPMSQ). Death was determined by search of the National Death Index, and all deaths through 2000 are included.

Results

Using World Health Organization (WHO) criteria, the prevalence of anemia was 24%. There was a strong racial difference with an odds ratio, adjusted for age, education, estimated glomerular filtration rate and comorbidity of 3.0 (95% CI, 2.3-3.9) in African Americans compared with Caucasians. The risk ratio for 8-year mortality was 1.7 (95% CI, 1.5-2.0) for anemic subjects (P = .0001) and did not differ by sex or race. Anemia was strongly associated with poorer physical function (P = .0001) and cognitive function (P = .0001), and predicted decreases in both over a 4-year period.

Conclusions

In an elderly community-based population, anemia is more prevalent in African Americans and is independently associated with increased mortality over 8 years for both races and sexs. Anemia also is a risk factor for functional and cognitive decrease.

Section snippets

Subjects

Subjects were participants in the Duke Established Populations for Epidemiologic Studies of the Elderly, a component of the four-site National Institute on Aging study.13, 14, 15 This study was approved by the Duke institutional review board, and informed consent was obtained from each participant and proxy. The study enrolled 4162 participants aged 65 years or older who were selected in a random household sample of a five-county area including and adjacent to Durham, NC in 1986.

African

Results

Baseline characteristics of the study participants are shown in Table 1. Participants consisted of 1744 community-dwelling men and women aged 71 to 102 years. The mean (± SD) age of the total sample was 78 (± 5.42) years, and 65% were female. Using WHO criteria, the prevalence of anemia was 24%. It was age related; 17% (65-74), 25% (75-79), 32% (>80), P <.0001, but not sex related. Two hundred eighty women (33%) and 146 men (31%) met criteria for anemia, P = .73. Those with anemia were older,

Discussion

This study of 1744 community-dwelling persons aged 71 years or older provides important information about the impact of anemia in an ethnically diverse population. The prevalence of anemia found in our patient population was higher than that seen in other community-dwelling elderly populations of predominantly Norwegian ancestry and higher than the prevalence recently reported from the NHANES III data.3, 4, 20, 21 African Americans accounted for 54% of our patient population and had a

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    This work was supported by contract N01 AG-12102 from the National Institute on Aging, NIH, Established Populations for Epidemiologic Studies of the Elderly; in part by grant 5 P60 AG-11268 from the National Institute on Aging, NIH, Claude D. Pepper Older Americans Independence Centers; and Grant 2002-0269, The John A. Hartford Foundation Center of Excellence.

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