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December 1, 1999


Author Affiliations

Phil B.FontanarosaMD, Interim CoeditorIndividualAuthorMargaret A.WinkerMD, Deputy EditorIndividualAuthorStephenLurieMD PhD, Fishbein FellowIndividualAuthor

JAMA. 1999;282(21):2001. doi:10-1001/pubs.JAMA-ISSN-0098-7484-282-21-jbk1201

In Reply: Dr Hassaballa correctly notes that the increased mortality risk associated with anemia in older persons disappeared after 5 to 10 years of follow-up in our study. Several mechanisms may explain why the mortality risk decreases after long periods of follow-up. First, chronic but nonfatal diseases may have caused the anemia in persons who were still alive 5 years after blood sampling. Second, the hemoglobin concentration measured at baseline may have been incidentally low due to nonfatal intercurrent disease. Third, the underlying disease causing anemia could have been successfully treated. Fourth, the number of persons with anemia who were alive 5 years after blood sampling was small (n = 18). Therefore, the study may simply lack power to detect different mortality in persons with and without anemia after long periods of follow-up.