The definition of anemia in older persons

Context Whether hemoglobin concentrations defined as anemia by the World He alth Organization (WHO) are associated with increased mortality in older pe rsons is not known. Objective To investigate the association between hemoglobin concentration a nd 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 we re eligible and 872 agreed to have a blood sample taken. Hemoglobin concent ration was measured in 755 persons (74%), Main Outcome Measures Hemoglobin concentration, 10-year survival, and prima ry cause of death. According to the WHO criteria, anemia was defined as a h emoglobin concentration below 7.5 mmol/L (120 g/L) in women and below 8.1 m mol/L (130 g/L) in men. Results Compared with persons with a normal hemoglobin concentration, the m ortality 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 concent rations. 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 f rom malignant and infectious diseases was higher in persons with anemia. Conclusions Anemia defined by the WHO criteria was associated with an incre ased mortality risk in persons aged 85 years and older. The criteria are th us appropriate for older persons. A low hemoglobin concentration at old age signifies disease.