Endres Heinz G, Wedding Ulrich, Pittrow David, Thiem Ulrich, Trampisch Hans J, Diehm Curt
Department of Medical Informatics, Statistics and Epidemiology, Ruhr University Bochum, Bochum, Germany.
Curr Med Res Opin. 2009 May;25(5):1143-58. doi: 10.1185/03007990902860325.
Increased mortality in patients with anemia has been demonstrated in disabled, seriously ill or hospitalized patients. In industrialized nations with their aging societies, however, elderly but apparently healthy family-physician patients are an important demographic group from a public-health perspective. We therefore set out to evaluate the prevalence of anemia in this group and associations between anemia and 5-year all-cause mortality, adjusted for multiple other established risk factors and chronic diseases.
This was a monitored, prospective cohort study in Germany with 344 representative family physicians who documented, consecutively, elderly patients (aged >or= 65 years). Extensive fasting plasma parameters were collected at baseline. Anemia at inclusion was defined according to World Health Organization criteria (hemoglobin below 12 g/dl in women and 13 g/dl in men). All participants were followed up for death of any cause for 5.3 years.
Among the 6880 individuals, 2905 men and 3975 women, aged 65-95 (mean age 72.5), mild anemia (hemoglobin levels >or=10 g/dl) was found in 6.1% of women and 8.1% of men. Among those patients, 36.1% of anemic men and 15.0% of anemic women died. In a Cox proportional hazards analysis, multiple adjusted for potential confounders including major comorbidities, a near doubling of the 5-year mortality risk in anemic men (hazard ratio [HR] 1.9; 95% confidence interval [CI] 1.5-2.4) was found, while in anemic women there was no risk increase at all (HR 1.1; 95% CI 0.8-1.6). Even if patients with the lowest hemoglobin concentration (<11 g/dl for women, <12 g/dl for men) are singled out for multiple-adjusted analysis, anemia in men was related to a significant mortality risk (HR 3.3; 95% CI 2.1-5.1), but not in women (HR 1.85; 95% CI 0.97-3.53).
In typical elderly patients without severe comorbidities, mild anemia was significantly associated with greater mortality in men but not in women. Given the impact of sex on outcomes of older subjects with mild anemia, the current definition of anemia should be adjusted for elderly males towards a higher hemoglobin threshold. Interventional trials will be needed to determine whether a consistent correction of anemia improves mortality of older men.
贫血患者死亡率增加在残疾、重症或住院患者中已得到证实。然而，在老龄化社会的工业化国家，从公共卫生角度来看，看似健康的老年家庭医生患者是一个重要的人口群体。因此，我们着手评估该群体中贫血的患病率，以及贫血与5年全因死亡率之间的关联，并对其他多种既定风险因素和慢性疾病进行校正。
这是一项在德国进行的监测前瞻性队列研究，有344名代表性家庭医生连续记录老年患者（年龄≥65岁）。在基线时收集了广泛的空腹血浆参数。纳入时的贫血根据世界卫生组织标准定义（女性血红蛋白低于12 g/dl，男性低于13 g/dl）。所有参与者均随访5.3年以观察任何原因导致的死亡情况。
在6880名个体中，年龄在65 - 95岁（平均年龄72.5岁），有2905名男性和3975名女性，6.1%的女性和8.1%的男性存在轻度贫血（血红蛋白水平≥10 g/dl）。在这些患者中，36.1%的贫血男性和15.0%的贫血女性死亡。在Cox比例风险分析中，对包括主要合并症在内的潜在混杂因素进行多重校正后，发现贫血男性的5年死亡风险几乎翻倍（风险比[HR] 1.9；95%置信区间[CI] 1.5 - 2.4），而贫血女性根本没有风险增加（HR 1.1；95% CI 0.8 - 1.6）。即使将血红蛋白浓度最低的患者（女性<11 g/dl，男性<12 g/dl）挑选出来进行多重校正分析，男性贫血与显著的死亡风险相关（HR 3.3；95% CI 2.1 - 5.1），但女性并非如此（HR 1.85；95% CI 0.97 - 3.53）。
在没有严重合并症的典型老年患者中，轻度贫血与男性更高的死亡率显著相关，但与女性无关。鉴于性别对轻度贫血老年受试者结局的影响，贫血的现行定义应针对老年男性将血红蛋白阈值调高。需要进行干预试验以确定持续纠正贫血是否能改善老年男性的死亡率。
