Wangping Jia, Ke Han, Shengshu Wang, Yang Song, Shanshan Yang, Wenzhe Cao, Yao He, Miao Liu
Graduate School, Chinese People's Liberation Army General Hospital, Beijing, China.
Beijing Key Laboratory of Aging and Geriatrics, National Clinical Research Center for Geriatrics Diseases, Institute of Geriatrics, Second Medical Center of Chinese People's Liberation Army General Hospital, Beijing, China.
Front Med (Lausanne). 2021 Feb 10;8:613426. doi: 10.3389/fmed.2021.613426. eCollection 2021.
To evaluate the combined effects of anemia and cognitive function on the risk of all-cause mortality in oldest-old individuals. Prospective population-based cohort study. We included 1,212 oldest-old individuals (men, 416; mean age, 93.3 years). Blood tests, physical examinations, and health questionnaire surveys were conducted in 2012 were used for baseline data. Mortality was assessed in the subsequent 2014 and 2018 survey waves. Cox proportional hazards models were used to evaluate anemia, cognitive impairment, and mortality risk. We used restricted cubic splines to analyze and visualize the association between hemoglobin (Hb) levels and mortality risk. A total of 801 (66.1%) deaths were identified during the 6-year follow-up. We noted a significant association between anemia and mortality (hazard ratio [HR] 1.32, 95% confidence interval [CI] 1.14-1.54) after adjusting for confounding variables. We also observed a dose-response relationship between the severity of anemia and mortality ( < 0.001). In the restricted cubic spline models, Hb levels had a reverse J-shaped association with mortality risk (HR 0.88, 95% CI 0.84-0.93 per 10 g/L-increase in Hb levels below 130 g/L). The reverse J-shaped association persisted in individuals without cognitive impairment (HR 0.88, 95% CI 0.79-0.98 per 10 g/L-increase in Hb levels below 110 g/L). For people with cognitive impairment, Hb levels were inversely associated with mortality risk (HR 0.83, 95% CI 0.78-0.89 per 10 g/L-increase in Hb levels below 150 g/L). People with anemia and cognitive impairment had the highest risk of mortality (HR 2.60, 95% CI 2.06-3.27). Our results indicate that anemia is associated with an increased risk of mortality in oldest-old people. Cognitive impairment modifies the association between Hb levels and mortality.
评估贫血与认知功能对高龄老人全因死亡风险的综合影响。前瞻性基于人群的队列研究。我们纳入了1212名高龄老人（男性416名；平均年龄93.3岁）。2012年进行的血液检测、体格检查和健康问卷调查被用作基线数据。在随后2014年和2018年的调查波次中评估死亡率。采用Cox比例风险模型评估贫血、认知障碍和死亡风险。我们使用受限立方样条来分析和可视化血红蛋白（Hb）水平与死亡风险之间的关联。在6年随访期间共确定了801例（66.1%）死亡病例。在调整混杂变量后，我们注意到贫血与死亡率之间存在显著关联（风险比[HR]1.32，95%置信区间[CI]1.14 - 1.54）。我们还观察到贫血严重程度与死亡率之间存在剂量反应关系（<0.001）。在受限立方样条模型中，Hb水平与死亡风险呈倒J形关联（每10 g/L Hb水平升高，低于130 g/L时HR为0.88，95% CI为0.84 - 0.93）。这种倒J形关联在无认知障碍的个体中持续存在（每10 g/L Hb水平升高，低于110 g/L时HR为0.88，95% CI为0.79 - 0.98）。对于有认知障碍的人，Hb水平与死亡风险呈负相关（每10 g/L Hb水平升高，低于150 g/L时HR为0.83，95% CI为0.78 - 0.89）。贫血且有认知障碍的人死亡风险最高（HR 2.60，95% CI 2.06 - 3.27）。我们的结果表明，贫血与高龄老人死亡风险增加有关。认知障碍改变了Hb水平与死亡率之间的关联。
