Department of Internal Medicine, University of São Paulo Medical School, São Paulo, Brazil.
Geriatr Gerontol Int. 2013 Jan;13(1):204-8. doi: 10.1111/j.1447-0594.2012.00888.x. Epub 2012 Jun 11.
Anemia is a prevalent condition in older people, and associated with increased morbidity and mortality. Previous studies identified various causes of anemia in this population. We aimed to determine the frequency and main causes of persistent or recurrent anemia in participants 2 years after their inclusion in the São Paulo Ageing & Health Study (SPAH).
The SPAH is a cohort study of 2072 individuals aged 65 years or older living in poor neighborhoods of São Paulo, Brazil. A total of 2 years after inclusion, participants were reassessed; those with anemia at baseline were eligible for this ancillary study. Individuals were invited to a medical re-evaluation, including taking blood samples to determine serum iron, ferritin, total iron-binding capacity, folic acid, vitamin B(12), creatinine and transferrin saturation levels, and blood cell and reticulocyte counts. Anemia diagnosis was based on WHO criteria. Information about cause of death before follow-up assessment was obtained from death certificates.
Of the 203 participants with anemia at inclusion, 97 (47.8%) were reassessed, 48 (23.6%) died before follow-up assessment, 33 (16.3%) refused to participate and 25 (12.3%) were not traced. A total of 57 (58.8%) of the 97 re-evaluated participants had persistent or recurrent anemia. Lower baseline hemoglobin was a predictor of anemia during follow up. Major causes of persistent or recurrent anemia at follow up were renal disease (62%) and chronic inflammation (35%).
Anemia was a prevalent and persistent disease in this low-income sample of older individuals. Micronutrient-related anemia, chronic blood loss and renal disease are important mechanisms for perpetuating low hemoglobin levels.
贫血是老年人中普遍存在的病症，与发病率和死亡率的增加有关。先前的研究确定了该人群中贫血的各种原因。我们旨在确定在纳入圣保罗老龄化与健康研究（SPAH）2 年后，参与者中持续性或复发性贫血的频率和主要原因。
SPAH 是一项针对巴西圣保罗贫困社区 2072 名 65 岁或以上老年人的队列研究。在纳入后 2 年，对参与者进行了重新评估；基线时有贫血的参与者有资格参加这项辅助研究。邀请个人进行医学复查，包括采集血液样本以确定血清铁、铁蛋白、总铁结合能力、叶酸、维生素 B12、肌酐和转铁蛋白饱和度以及血细胞和网织红细胞计数。贫血诊断基于世界卫生组织（WHO）标准。在随访评估之前，通过死亡证明获得有关死亡原因的信息。
在纳入时有贫血的 203 名参与者中，有 97 名（47.8%）接受了重新评估，48 名（23.6%）在随访评估前死亡，33 名（16.3%）拒绝参与，25 名（12.3%）无法追踪。在 97 名接受重新评估的参与者中，共有 57 名（58.8%）患有持续性或复发性贫血。基线时较低的血红蛋白是随访期间贫血的预测因素。持续性或复发性贫血的主要原因是肾脏疾病（62%）和慢性炎症（35%）。
在这个低收入的老年人群体样本中，贫血是一种普遍且持续存在的疾病。与微量营养素相关的贫血、慢性失血和肾脏疾病是维持低血红蛋白水平的重要机制。
