The Definition of Anemia in Older Persons
Abstract
CONTEXT: Whether hemoglobin concentrations defined as anemia by the World Health Organization (WHO) are associated with increased mortality in older persons is not known. OBJECTIVE: To investigate the association between hemoglobin concentration and cause-specific mortality in older persons. DESIGN: Community-based study conducted from 1986 to 1996 (follow-up period, 10 years). SETTING: Leiden, the Netherlands. PARTICIPANTS: A total of 1016 community residents aged 85 years and older were eligible and 872 agreed to have a blood sample taken. Hemoglobin concentration was measured in 755 persons (74%). MAIN OUTCOME MEASURES: Hemoglobin concentration, 10-year survival, and primary cause of death. According to the WHO criteria, anemia was defined as a hemoglobin concentration below 7.5 mmol/L (120 g/L) in women and below 8.1 mmol/L (130 g/L) in men. RESULTS: Compared with persons with a normal hemoglobin concentration, the mortality risk was 1.60 (95% confidence interval [CI], 1.24-2.06; P<.001) in women with anemia, and 2.29 (95% CI, 1.60-3.26; P<.001) in men with anemia. In both sexes, the mortality risk increased with lower hemoglobin concentrations. In persons without self-reported clinical disease at baseline, the mortality risk of anemia was 2.21 (95% CI, 1.37-3.57; P=.002). Mortality from malignant and infectious diseases was higher in persons with anemia. CONCLUSIONS: Anemia defined by the WHO criteria was associated with an increased mortality risk in persons aged 85 years and older. The criteria are thus appropriate for older persons. A low hemoglobin concentration at old age signifies disease.
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Serum hepcidin was measured by ELISA with sensitivity 5 ng/mL, interassay CV 12%, and range 29-254 ng/mL in men.
“Serum hepcidin was measured by enzyme-linked immunosorbent assay (Intrinsic Life Sciences) with sensitivity of 5 ng/mL, interassay coefficient of variation 12%, and range 29-254 ng/ mL in men (12,15).”
From Testosterone induces erythrocytosis via increased erythropoietin and suppressed hepcidin: evidence for a new erythropoietin/hemoglobin set point (2014) · cites this paper as [15]
Serum hepcidin and ferritin levels were within reference ranges and similar between groups at baseline.
“Serum hepcidin and ferritin levels were within the reported reference ranges for men and similar between groups (15).”
From Testosterone induces erythrocytosis via increased erythropoietin and suppressed hepcidin: evidence for a new erythropoietin/hemoglobin set point (2014) · cites this paper as [15]
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- Authors
- Izaks, G. J.
- Affiliations
- Leiden University Medical Center (NL)
- Corresponding author
- Izaks, Gerbrand J.
- ORCID
- Izaks, Gerbrand J.
- Venue
- JAMA
- Publisher
- American Medical Association (AMA)
- Published
- 1999-05-12
- Volume
- 281
- Issue
- 18
- Pages
- 1714
- ISSN
- 0002-9955 (ISSN-L)
- 0098-7484
- OpenAlex
- W2034859046
- Cited by
- 495
- References
- 11
- Citations by year
- 2026: 2 · 2025: 8 · 2024: 10 · 2023: 12 · 2022: 17 · 2021: 13 · 2020: 14 · 2019: 21 · 2018: 21 · 2017: 16 · 2016: 12 · 2015: 24 · 2014: 24 · 2013: 21 · 2012: 34
- FWCI
- 3.93
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- JAMA (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institutes of Health (1r01ag006354-01)
- National Institute on Aging (AG-06354)
- Topics
- Health Sciences › Medicine › Hematology › Iron Metabolism and Disorders
- Health Sciences › Medicine › Hematology › Erythropoietin and Anemia Treatment
- Health Sciences › Medicine › Physiology › Nutrition and Health in Aging
- Keywords
- anemia, hemoglobin levels, older adults, mortality, cause-specific mortality, survival, sex differences, infectious disease mortality
- MeSH terms
- Aged, Aged, 80 and over, Anemia, Cause of Death, Female, Hemoglobins, Humans, Male, Risk, Proportional Hazards Models, Survival Analysis
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