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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
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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