Epidemiology of Anemia in Older Adults
Section snippets
Prevalence by Age and Sex
Estimates of anemia prevalence vary depending on the case definition applied and the demographic and health status composition of study samples. Although there is some debate on which hemoglobin thresholds should be used to define anemia in older adults, the World Health Organization (WHO) definition (hemoglobin concentration <12 g/dL in women and <13 g/dL in men) is the most frequently used in epidemiologic studies. Further, older persons with hemoglobin concentration below the WHO cutoffs are
Types of Anemia
The high burden of comorbidity and accompanying polypharmacy among older adults make it difficult to determine the underlying cause of anemia in this population. In the NHANES III, for example, approximately two thirds of participants with anemia had two or more age-associated diseases.10 Nonetheless, anemia in older persons is generally subdivided into four major types according to cause: anemia related to nutrient deficiencies, chronic kidney disease, chronic disease or inflammation, and
Association of Anemia With Mortality
Several large cohort studies have demonstrated that WHO-defined anemia is associated with increased risk of death among older adults.5, 6, 7, 8, 9 Associations were robust to extensive adjustment for potential confounding factors, with adjusted hazard ratios comparing anemic to non-anemic older adults ranging from 1.4 to 2.7. Three studies even showed that the effect of anemia on survival remained significant even after excluding participants with major age-associated conditions.6, 7, 8 Most
Conclusions
Anemia is a common, multifactorial condition among older adults that is associated with a variety of adverse outcomes, including mortality. While the epidemiology of anemia has advanced considerably in recent years, further investigation of several areas is needed. More outcomes-based research should be pursued to help define the hemoglobin threshold at which anemia occurs by race and sex. A larger effort is needed to better characterize the dynamics of anemia onset, chronicity, and recovery.
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Supported by the Intramural Research Program of the US National Institute on Aging, National Institutes of Health.