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Red Blood Cell Distribution Width and the Risk of Death in Middle-aged and Older Adults
Open accessAbstract
BACKGROUND: Red blood cell distribution width (RDW), a component of an electronic complete blood count, is a measure of heterogeneity in the size of circulating erythrocytes. In patients with symptomatic cardiovascular disease (CVD), RDW is associated with mortality. However, it has not been demonstrated that RDW is a predictor of mortality independent of nutritional deficiencies or in the general population. METHODS: Red blood cell distribution width was measured in a national sample of 8175 community-dwelling adults 45 years or older who participated in the 1988-1994 National Health and Nutrition Examination Survey; mortality follow-up occurred through December 31, 2000. Deaths from all causes, CVD, cancer, and other causes were examined as a function of RDW. RESULTS: Higher RDW values were strongly associated with an increased risk of death. Compared with the lowest quintile of RDW, the following were adjusted hazard ratios (HRs) for all-cause mortality (and 95% confidence intervals [CIs]): second quintile, HR, 1.1 (95% CI, 0.9-1.3); third quintile, HR, 1.2 (95% CI, 1.0-1.4); fourth quintile, HR, 1.4 (95% CI, 1.2-1.8); and fifth quintile, HR, 2.1 (95% CI, 1.7-2.6). For every 1% increment in RDW, all-cause mortality risk increased by 22% (HR, 1.22; 95% CI, 1.15-1.30; P < .001). Even when analyses were restricted to nonanemic participants or to those in the reference range of RDW (11%-15%) without iron, folate, or vitamin B(12) deficiency, RDW remained strongly associated with mortality. The prognostic effect of RDW was observed in both middle-aged and older adults for multiple causes of death. CONCLUSION: Red blood cell distribution width is a widely available test that is a strong predictor of mortality in the general population of adults 45 years or older.
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“Like several other well-described markers in blood cells, such as red cell distribution width 83, DNA methylation clocks 84, and loss of Y-chromosome 85, CHIP is associated with multiple adverse outcomes in epidemiological studies.”
From Clonal hematopoiesis in human aging and disease (2019) · cites this paper as [83]
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Metadata
- Authors
- Patel, K. V., Ferrucci, L., Ershler, W. B., Longo, D. L., & Guralnik, J. M.
- Affiliations
- National Institutes of Health (US)
- Venue
- Archives of Internal Medicine
- Publisher
- American Medical Association (AMA)
- Published
- 2009-03-09
- Volume
- 169
- Issue
- 5
- Pages
- 515
- ISSN
- 0003-9926 (ISSN-L)
- PMC
- PMC2765040
- OpenAlex
- W2060671390
- Cited by
- 618
- References
- 24
- Citations by year
- 2026: 28 · 2025: 24 · 2024: 21 · 2023: 40 · 2022: 37 · 2021: 52 · 2020: 45 · 2019: 33 · 2018: 39 · 2017: 43 · 2016: 46 · 2015: 45 · 2014: 48 · 2013: 35 · 2012: 41
- FWCI
- 13.48
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Archives of Internal Medicine (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institutes of Health (Z99 AG999999)
- Topics
- Health Sciences › Medicine › Oncology › Inflammatory Biomarkers in Disease Prognosis
- Health Sciences › Medicine › Hematology › Blood properties and coagulation
- Health Sciences › Medicine › Physiology (medical) › Erythrocyte Function and Pathophysiology
- Keywords
- red cell distribution width, all-cause mortality, mortality prediction, complete blood count, middle-aged and older adults, cardiovascular mortality, cancer mortality, nutritional deficiency, iron deficiency, folate deficiency, vitamin B12 deficiency
- MeSH terms
- Aged, Erythrocyte Indices, Erythrocytes, Female, Humans, Male, Middle Aged, Mortality, Risk Factors
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