Cited by 495Iron Metabolism and DisordersErythropoietin and Anemia TreatmentNutrition and Health in Aging

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The Definition of Anemia in Older Persons

Izaks, Gerbrand J.·1999·JAMA

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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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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
DOI: 10.1001/jama.281.18.1714
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 (medical) › 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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The Definition of Anemia in Older Persons

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