Department of Hematology, University Medical Center Groningen, the Netherlands
Department of Endocrinology, University Medical Center Groningen, the Netherlands.
Haematologica. 2019 Mar;104(3):468-476. doi: 10.3324/haematol.2018.195552. Epub 2018 Oct 11.
Anemia is highly prevalent, especially in older individuals. In selected populations, anemia has been reported to be associated with impaired survival and health-related quality of life. However, data on this impact in the general population are rare. Furthermore, discussions on the optimal definition of anemia have not been conclusive. We investigated these issues using survival data, scores from a health-related quality of life questionnaire (RAND-36), and hemoglobin concentration from 138670 subjects, aged 18-93 years, participating in the Lifelines cohort. Anemia was defined according to World Health Organization criteria and was further subclassified in participants over 60 years old. Anemia was present in 5510 (4.0%) of all 138670 subjects and 516 (2.8%) in the 18667 individuals older than 60 years. Anemia had no impact on overall survival and limited impact on health-related quality of life in individuals less than 60 years old. In contrast, in individuals over 60 years old anemia significantly impaired overall survival and health-related quality of life. The lower health-related quality of life was mainly observed in subscales representing physical functioning. Although consensus on the subclassification of anemia is lacking, our data suggest that particularly anemia of chronic inflammation was associated with worse overall survival and decreased health-related quality of life. Multivariate models confirmed that anemia was an independent risk factor for decreased health-related quality of life in older individuals. Finally, women with a hemoglobin concentration between 12.0-13.0 g/dL (considered anemia in men, but not in women) experienced a significantly lower health-related quality of life. This large, prospective, population-based study indicates that anemia is associated with worse overall survival and health-related quality of life in older individuals, but not in younger individuals. The findings of this study challenge the definition of anemia in women over 60 years old, and suggest that the optimal definition of anemia, in the perspective of health-related quality of life, in women over 60 years old should be altered to a hemoglobin concentration below 13.0 g/dL (8.0 mmol/L), which is comparable to that in men.
贫血症非常普遍，尤其是在老年人中。在特定人群中，贫血症与生存率和健康相关生活质量受损有关。然而，在普通人群中，关于这方面影响的数据却很少。此外，关于贫血症最佳定义的讨论也没有定论。我们使用生存数据、健康相关生活质量问卷（RAND-36）评分以及来自参加 Lifelines 队列的 138670 名 18-93 岁的参与者的血红蛋白浓度来研究这些问题。贫血症根据世界卫生组织的标准进行定义，并进一步在 60 岁以上的参与者中进行了分类。在 138670 名参与者中，有 5510 名（4.0%）存在贫血症，而在 18667 名 60 岁以上的参与者中，有 516 名（2.8%）存在贫血症。贫血症对 60 岁以下的个体的总体生存率没有影响，对健康相关生活质量的影响有限。相反，在 60 岁以上的个体中，贫血症显著降低了总体生存率和健康相关生活质量。健康相关生活质量的下降主要发生在代表身体功能的子量表中。尽管对贫血症的分类缺乏共识，但我们的数据表明，特别是慢性炎症性贫血与总体生存率降低和健康相关生活质量下降有关。多变量模型证实，贫血症是 60 岁以上个体健康相关生活质量下降的独立危险因素。最后，血红蛋白浓度在 12.0-13.0 g/dL 之间的女性（被认为是男性贫血，但不是女性贫血）经历的健康相关生活质量明显较低。这项大型、前瞻性、基于人群的研究表明，贫血症与老年人的总体生存率和健康相关生活质量较差有关，但与年轻人无关。这项研究的结果挑战了 60 岁以上女性贫血症的定义，并表明从健康相关生活质量的角度来看，60 岁以上女性贫血症的最佳定义应更改为血红蛋白浓度低于 13.0 g/dL（8.0 mmol/L），与男性相当。
