School of Applied Sciences, University of Campinas, Limeira, SP, Brazil.
Department of Medical Surgical Nursing, School of Nursing, University of Sao Paulo, São Paulo, SP, Brazil.
Geriatr Gerontol Int. 2018 Jan;18(1):177-182. doi: 10.1111/ggi.13137. Epub 2017 Aug 6.
The aim of the present study was to analyze the impact of anemia and hypoalbuminemia on mortality in a 5-year period.
This was longitudinal population-based observational survey part of the Saúde, Bem-Estar e Envelhecimento study (Health, Well-being and Aging), carried out with 1256 older adults from the third wave of the cohort, followed for 5 years, when they were contacted for the fourth wave, in Sao Paulo, Brazil. Anemia was defined when hemoglobin was <12 g/dL for women and <13 g/dL for men, and hypoalbuminemia when serum albumin was <3.5 g/dL. Survival functions were estimated according to nutritional status in four groups: (i) without nutritional alteration; (ii) anemia only; (iii) hypoalbuminemia only; and (iv) anemia and hypoalbuminemia. Hazard ratios were calculated, following the Cox proportional hazards model, controlling for baseline covariates. All analyses considered sample weights, and were carried out using the Stata 12.
After the 5-year period, 12.3% of the participants died, and 8.2% were lost to follow up. Those who died had lower hemoglobin and albumin concentrations (13.4 g/dL and 3.7 g/dL) compared with survivors (14.3d/dL and 3.9 g/dL; P < 0.001). The crude death rate was 27.6/1000 person-years for participants in group i, 124.3 in group ii, 116.0 in group iii and 222.8 in group iv (P < 0.001). In the final Cox models, group 2 and 3 had a similar effect (hazard ratio 2.23, P = 0.020; 2.53, P = 0.005; respectively) and group 4 had a higher risk (hazard ratio 3.36; P = 0.004).
Anemia and hypoalbuminemia are important markers for death in older adults, and have an additive effect on mortality. Because they are common and cost-effective biomarkers, their use should be encouraged in geriatric evaluation for all health professionals and in population settings, such as primary care. Geriatr Gerontol Int 2018; 18: 177-182.
本研究旨在分析贫血和低蛋白血症对 5 年内死亡率的影响。
这是一项基于人群的纵向观察性研究，是 Saúde, Bem-Estar e Envelhecimento 研究（健康、幸福与衰老）的一部分，纳入了来自巴西圣保罗的 1256 名老年参与者，这些参与者为第三波队列研究的成员，随访 5 年后，在第四波研究中对他们进行了联系。当血红蛋白女性<12g/dL，男性<13g/dL 时，定义为贫血；当血清白蛋白<3.5g/dL 时，定义为低蛋白血症。根据营养状况将生存功能估计为四个组：（i）无营养改变；（ii）仅贫血；（iii）仅低蛋白血症；和（iv）贫血和低蛋白血症。使用 Cox 比例风险模型计算危险比，控制基线协变量。所有分析均考虑了样本权重，并使用 Stata 12 进行分析。
在 5 年期间，有 12.3%的参与者死亡，8.2%的参与者失访。与幸存者相比，死亡者的血红蛋白和白蛋白浓度较低（13.4g/dL 和 3.7g/dL），而幸存者的血红蛋白和白蛋白浓度较高（14.3d/dL 和 3.9g/dL；P<0.001）。第 i 组参与者的粗死亡率为 27.6/1000 人年，第 ii 组为 124.3/1000 人年，第 iii 组为 116.0/1000 人年，第 iv 组为 222.8/1000 人年（P<0.001）。在最终的 Cox 模型中，第 2 组和第 3 组的影响相似（危险比 2.23，P=0.020；2.53，P=0.005），第 4 组的风险更高（危险比 3.36；P=0.004）。
贫血和低蛋白血症是老年人死亡的重要标志物，对死亡率有相加作用。由于它们是常见且具有成本效益的生物标志物，因此应鼓励所有卫生专业人员在老年评估和初级保健等人群环境中使用。
