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Ferrata Storti Foundation
Red Cell Biology & its Disorders
Association of anemia with health-related quality of life and survival: a large population-based cohort study
Haematologica 2019 Volume 104(3):468-476
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Hanneke J.C.M. Wouters,1,2 Melanie M. van der Klauw,2 Theo de Witte,3 Reinhard Stauder,4 Dorine W. Swinkels,5,6 Bruce H.R. Wolffenbuttel2 and Gerwin Huls1
1Department of Hematology, University Medical Center Groningen, the Netherlands; 2Department of Endocrinology, University Medical Center Groningen, the Netherlands;
Department of Hematology, Radboud University Medical Center, Nijmegen, the Netherlands; 4Department of Internal Medicine V (Hematology and Oncology), Medical University, Innsbruck, Austria; 5Department of Laboratory Medicine, Radboud University Medical Center, Nijmegen, the Netherlands and 6Hepcidinanalysis.com, Nijmegen, the Netherlands
HJCMW and MMvdK contributed equally to this work. BHRW and GH contributed equally to this work.
ABSTRACT
Anemia is highly prevalent, especially in older individuals. In select- ed 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, discus- sions 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 con- sensus 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 (con- sidered 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 sur- vival 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 def- inition of anemia, in the perspective of health-related quality of life, in women over 60 years old should be altered to a hemoglobin concentra- tion below 13.0 g/dL (8.0 mmol/L), which is comparable to that in men.
Correspondence:
HANNEKE J.C.M. WOUTERS
h.j.c.m.wouters@umcg.nl
Received: April 11, 2018. Accepted: October 2, 2018. Pre-published: October 11, 2018.
doi:10.3324/haematol.2018.195552
Check the online version for the most updated information on this article, online supplements, and information on authorship & disclosures: www.haematologica.org/content/104/3/468
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