den Elzen Wendy P J, Willems Jorien M, Westendorp Rudi G J, de Craen Anton J M, Assendelft Willem J J, Gussekloo Jacobijn
Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, the Netherlands.
CMAJ. 2009 Aug 4;181(3-4):151-7. doi: 10.1503/cmaj.090040. Epub 2009 Jul 27.
There is limited insight into the attributable effect of anemia and comorbidity on functional status and mortality in old age.
The Leiden 85-plus Study is a population-based prospective follow-up study of 562 people aged 85 years. Anemia was defined according to World Health Organization criteria. We measured 3 parameters of functional status at baseline and annually thereafter for 5 years: disability in basic and instrumental activities of daily living, cognitive function and the presence of depressive symptoms. We obtained mortality data from the municipal registry.
The prevalence of anemia at baseline was 26.7% (150/562). Participants who had anemia at baseline had more disability in activities of daily living, worse cognitive function and more depressive symptoms than participants without anemia at baseline (p <or= 0.01). These differences disappeared after adjustment for comorbidity. After adjustment for comorbidity in the prospective analyses, anemia at baseline was associated with an additional increase in disability in instrumental activities of daily living during follow-up; incident anemia during follow-up (n = 99) was associated with an additional increase in disability in basic activities of daily living. Prevalent and incident anemia were both associated with an increased risk of death, even after we adjusted for sex, education level, income, residence in a long-term care facility, C-reactive protein level, creatinine clearance and the presence of disease (hazard ratio for prevalent anemia 1.41, 95% confidence interval [CI] 1.13 to 1.76; hazard ratio for incident anemia 2.08, 95% CI 1.60 to 2.70).
Anemia in very elderly people appears to be associated with an increased risk of death, independent of comorbidity. However, the associated functional decline appears to be attributed mainly to comorbidity.
关于贫血和合并症对老年人功能状态及死亡率的归因影响，目前了解有限。
莱顿85岁及以上人群研究是一项基于人群的前瞻性随访研究，涉及562名85岁老人。贫血依据世界卫生组织标准定义。我们在基线时以及此后5年每年测量功能状态的3个参数：基本和工具性日常生活活动能力障碍、认知功能以及抑郁症状的存在情况。我们从市政登记处获取死亡率数据。
基线时贫血患病率为26.7%（150/562）。与基线时无贫血的参与者相比，基线时患有贫血的参与者在日常生活活动中残疾更多、认知功能更差且抑郁症状更多（p≤0.01）。在对合并症进行调整后，这些差异消失。在前瞻性分析中对合并症进行调整后，基线时的贫血与随访期间工具性日常生活活动能力残疾的额外增加相关；随访期间发生的贫血（n = 99）与基本日常生活活动能力残疾的额外增加相关。即使在我们对性别、教育水平、收入、长期护理机构居住情况、C反应蛋白水平、肌酐清除率和疾病存在情况进行调整后，现患贫血和新发贫血均与死亡风险增加相关（现患贫血的风险比为1.41，95%置信区间[CI]为1.13至1.76；新发贫血的风险比为2.08，95%CI为1.60至2.70）。
高龄老人贫血似乎与死亡风险增加相关，且独立于合并症。然而，相关的功能衰退似乎主要归因于合并症。
