A prospective study of anemia status, hemoglobin concentration, and mortality in an elderly cohort - The cardiovascular health study
A prospective study of anemia status, hemoglobin concentration, and mortality in an elderly cohort - The cardiovascular health study
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DOI：
10.1001/archinte.165.19.2214
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发表时间：
2005-10-24
影响因子：
--
通讯作者：
Cushman, M
中科院分区：
文献类型：
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作者：
Zakai, NA;Katz, R;Cushman, M
背景：贫血被认为是老年人群的不良预后因素；它对生存的独立影响尚不清楚。方法：基线血红蛋白五分之一和贫血，按照世界卫生组织的标准定义，在心血管健康研究中评估与死亡率的关系，这是一项前瞻性队列研究，随访了5888名65岁或以上的社区居民，于1989-1990年或1992-1993年在4个美国社区登记。结果：共有1205名参与者处于最低血红蛋白五分位数（男性< 13.7 g/dL，女性< 12.6 g/dL）， 498名（8.5%）参与者贫血（男性< 13 g/dL，女性< 12 g/dL）。与死亡率呈倒j型关系。观察;与第四个五分位数相比，第一和第五分位数经年龄、性别和种族调整的危险比（95%置信区间[CI]）分别为1.42 （95% CI, 1.25-1.62）和1.24 （95% CI, 1.09-1.42）。多因素调整后，这些风险比分别为1.33 （95% CI, 1.15-1.54）和1.17 （95% CI, 1.01-1.36）。人口统计学校正和完全校正的贫血死亡率风险比分别为1.57 （95% CI, 1.38-1.78）和1.38 （95% CI, 1.19-1.54）。调整贫血的原因和后果（肾功能、炎症或虚弱）并没有减少相关性。结论：根据世界卫生组织的标准，血红蛋白浓度的高低和贫血与死亡率的增加独立相关。世界卫生组织的标准没有像血红蛋白值较低那样确定风险。需要进一步研究老年人贫血的临床有效定义和原因，以及血红蛋白浓度极值时死亡率的增加。
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.