Page 69 - 2019_03-Haematologica-web

Anemia, survival and health-related quality of life
Figure 4. Risk of having a lower total health-related quality of life score than the (sex- and age-specific) 25th percentile cut-off according to hemoglobin concentrations.
The red rectangles indicate a hemoglobin concentration below the currently used World Health Organization definition of anemia. 95% CI: 95% confidence interval.
nature of the study, it was not possible to exclude the role of unknown or unmeasured confounding variables. A third limitation is that HRQoL was measured with the RAND-36 questionnaire, which is a generic health status questionnaire and not specifically developed to measure QoL in anemic individuals. Finally, it is possible that the results were influenced by volunteer bias.
This study indicates that anemia is associated with decreased survival and HRQoL, especially that concern- ing physical health, in individuals older than 60 years. After adjusting for confounding variables the impact of anemia was particularly present in individuals with ACI. These results suggest that older individuals might benefit from treatment to increase their hemoglobin values. Furthermore, this study challenges the sex-dependent definition of anemia in individuals older than 60 years, and suggests that in both men and women older than 60 years, the definition currently used in men [hemoglobin concentration <13.0 g/dL (8.0 mmol/L)] could be applied in perspective of HRQoL.
Acknowledgments
The authors would like to thank all participants of the Lifelines cohort study and everybody involved in the set-up and implementation of the study. We would also like to thank Anneke Geurts-Moespot and Siem Klaver of
Hepcidinanalysis.com, who contributed to the measurement of hepcidin.
Funding
Lifelines has been funded by a number of public sources, notably the Dutch Government, The Netherlands Organization of Scientific Research NOW (grant 175.010.2007.006), the Northern Netherlands Collaboration of Provinces (SNN), the European fund for regional development, Dutch Ministry of Economic Affairs, Pieken in de Delta, Provinces of Groningen and Drenthe, the Target project, BBMRI-NL, the University of Groningen, and the University Medical Center Groningen, the Netherlands. This work was supported by the National Consortium for Healthy Aging, and funds from the European Union’s Seventh Framework program (FP7/2007–2013) through the BioSHaRE-EU (Biobank Standardisation and Harmonisation for Research Excellence in the European Union) project, grant agreement 261,433. Lifelines (BRIF4568) is engaged in a Bioresource Research Impact Factor (BRIF) policy pilot study, details of which can be found at: http://bioshare.eu/content/bioresource-impact-factor.
This work is part of the MDS-RIGHT activities, which has received funding from the European Union’s Horizon 2020 research and innovation program under grant agreement n, 634789 - 'Providing the right care to the right patient with myelodysplastic syndrome at the right time'.
haematologica | 2019; 104(3)
475