Mugisha Joseph O, Baisley Kathy, Asiki Gershim, Seeley Janet, Kuper Hannah
MRC/UVRI Uganda Research Unit on AIDS, Entebbe, Uganda ; London School of Hygiene and Tropical Medicine, London, United Kingdom.
PLoS One. 2013 Oct 23;8(10):e78394. doi: 10.1371/journal.pone.0078394. eCollection 2013.
Studies conducted in high income countries have shown that anaemia is a common medical condition among older people, but such data are scarce in Africa. The objectives of this study were to estimate the prevalence, types, risk factors and clinical correlates of anaemia in older people.
Participants were aged (≥ 50) years recruited from a general population cohort from January 2012 to January 2013. Blood samples were collected for assessing hemoglobin, serum ferritin, serum vitamin B12, serum folate, C-reactive protein, malaria infection and stool samples for assessment of hookworm infection. HIV status was assessed using an algorithm for HIV rapid testing. Questionnaires were used to collect data on sociodemographic characteristics and other risk factors for anaemia.
In total, 1449 people participated (response rate 72.3%). The overall prevalence of anaemia was 20.3 % (95% CI 18.2-22.3%), and this was higher for males (24.1%, 95% CI=20.7-27.7%) than females (17.5%, 95% CI=15.0-20.1%). In males, the prevalence of anaemia increased rapidly with age almost doubling between 50 and 65 years (p-trend<0.001). Unexplained anaemia was responsible for more than half of all cases (59.7%). Anaemia was independently associated with infections including malaria (OR 3.49, 95% CI 1.78-6.82), HIV (OR 2.17, 1.32-3.57) heavy hookworm infection (OR 3.45, 1.73-6.91), low fruit consumption (OR 1.55, 1.05-2.29) and being unmarried (OR 1.37 , 95% CI 1.01-1.89). However, the odds of anaemia were lower among older people with elevated blood pressure (OR 0.47, 95% CI 0.29-0.77).
Anaemia control programmes in Uganda should target older people and should include interventions to treat and control hookworms and educational programs on diets that enhance iron absorption. Clinicians should consider screening older people with HIV or malaria for anaemia. Further studies should be done on unexplained anaemia and serum ferritin levels that predict iron deficiency anaemia in older people.
在高收入国家进行的研究表明，贫血是老年人中常见的病症，但非洲缺乏此类数据。本研究的目的是估计老年人贫血的患病率、类型、危险因素及临床关联因素。
研究对象为2012年1月至2013年1月从普通人群队列中招募的年龄≥50岁的参与者。采集血样以评估血红蛋白、血清铁蛋白、血清维生素B12、血清叶酸、C反应蛋白、疟疾感染情况，并采集粪便样本以评估钩虫感染情况。使用HIV快速检测算法评估HIV感染状况。通过问卷调查收集社会人口学特征及其他贫血危险因素的数据。
共有1449人参与研究（应答率72.3%）。贫血的总体患病率为20.3%（95%置信区间18.2 - 22.3%），男性患病率（24.1%，95%置信区间20.7 - 27.7%）高于女性（17.5%，95%置信区间15.0 - 20.1%）。在男性中，贫血患病率随年龄迅速上升，在50至65岁之间几乎翻倍（p趋势<0.001）。不明原因的贫血占所有病例的一半以上（59.7%）。贫血与包括疟疾（比值比3.49，95%置信区间1.78 - 6.82）、HIV（比值比2.17，1.32 - 3.57）、重度钩虫感染（比值比3.45，1.73 - 6.91）、水果摄入量低（比值比1.55，1.05 - 2.29）及未婚（比值比1.37，95%置信区间1.01 - 1.89）等感染独立相关。然而，血压升高的老年人贫血几率较低（比值比0.47，95%置信区间0.29 - 0.77）。
乌干达的贫血控制项目应以老年人为目标，应包括治疗和控制钩虫的干预措施以及关于促进铁吸收饮食的教育项目。临床医生应考虑对感染HIV或疟疾的老年人进行贫血筛查。应针对不明原因的贫血以及预测老年人缺铁性贫血的血清铁蛋白水平开展进一步研究。
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