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Izaks GJ, Westendorp RGJ, Knook DL. The Definition of Anemia in Older Persons. JAMA. 1999;281(18):1714–1717. doi:10.1001/jama.281.18.1714
Author Affiliations: Section of Gerontology and Geriatrics, Department of General Internal Medicine (Drs Izaks, Westendorp, and Knook) and Department of Clinical Epidemiology (Dr Westendorp), Leiden University Medical Center, Leiden, the Netherlands.
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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