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Anemia in the general population: prevalence, clinical correlates and prognostic impact.

Martinsson, Andreas LU ; Andersson, Charlotte LU ; Andell, Pontus LU ; Koul, Sasha LU ; Engström, Gunnar LU and Smith, Gustav LU (2014) In European Journal of Epidemiology 29(7). p.489-498
Abstract
Low hemoglobin concentration is associated with increased mortality, but there is disagreement with regard to the clinical definition of anemia. We aimed to evaluate the prevalence, clinical correlates and association with total and cause-specific long-term mortality across the hemoglobin distribution and for previously proposed definitions of anemia. Blood hemoglobin concentration and mean corpuscular volume was measured in participants of the Malmö diet and cancer study-a prospective cohort study, and related to baseline characteristics and outcomes during follow-up. Primary endpoints were all-cause mortality, cardiovascular mortality and cancer-related mortality. A U-shaped association of hemoglobin with total mortality was observed in... (More)
Low hemoglobin concentration is associated with increased mortality, but there is disagreement with regard to the clinical definition of anemia. We aimed to evaluate the prevalence, clinical correlates and association with total and cause-specific long-term mortality across the hemoglobin distribution and for previously proposed definitions of anemia. Blood hemoglobin concentration and mean corpuscular volume was measured in participants of the Malmö diet and cancer study-a prospective cohort study, and related to baseline characteristics and outcomes during follow-up. Primary endpoints were all-cause mortality, cardiovascular mortality and cancer-related mortality. A U-shaped association of hemoglobin with total mortality was observed in spline regression analyses, with nadir at hemoglobin 150 g/L among men and 130 g/L among women. Mortality increased steeply with more strict definitions of anemia, hazard ratio: 1.36, 1.94 and 2.16 for hemoglobin <140/130 (men/women), 132/122 and 130/120 g/L, respectively. Similar trends were seen for both cancer- and cardiovascular mortality. The incidence of coronary disease and cancer did not differ across groups. Erythrocyte volume was an independent predictor of mortality, with the highest mortality observed for macrocytic anemia, which was less prevalent than microcytic and normocytic anemia. Dietary intake of iron and vitamin B12 were significantly lower and use of antithrombotic medications was significantly higher in subjects with anemia. The World Health Organisation definition of anemia was associated with increased mortality (hazard ratio 2.16) but excess mortality was also observed at higher hemoglobin levels. Of morphological subtypes, anemia with macrocytosis was rare but associated with the highest mortality. (Less)
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author
organization
publishing date
type
Contribution to journal
publication status
published
subject
in
European Journal of Epidemiology
volume
29
issue
7
pages
489 - 498
publisher
Springer
external identifiers
  • pmid:24952166
  • wos:000339806000004
  • scopus:84904416124
ISSN
1573-7284
DOI
10.1007/s10654-014-9929-9
language
English
LU publication?
yes
id
4020e555-17dc-4815-93b6-0206df2f32fa (old id 4527380)
alternative location
http://www.ncbi.nlm.nih.gov/pubmed/24952166?dopt=Abstract
date added to LUP
2014-07-06 20:11:54
date last changed
2017-10-08 03:10:19
@article{4020e555-17dc-4815-93b6-0206df2f32fa,
  abstract     = {Low hemoglobin concentration is associated with increased mortality, but there is disagreement with regard to the clinical definition of anemia. We aimed to evaluate the prevalence, clinical correlates and association with total and cause-specific long-term mortality across the hemoglobin distribution and for previously proposed definitions of anemia. Blood hemoglobin concentration and mean corpuscular volume was measured in participants of the Malmö diet and cancer study-a prospective cohort study, and related to baseline characteristics and outcomes during follow-up. Primary endpoints were all-cause mortality, cardiovascular mortality and cancer-related mortality. A U-shaped association of hemoglobin with total mortality was observed in spline regression analyses, with nadir at hemoglobin 150 g/L among men and 130 g/L among women. Mortality increased steeply with more strict definitions of anemia, hazard ratio: 1.36, 1.94 and 2.16 for hemoglobin &lt;140/130 (men/women), 132/122 and 130/120 g/L, respectively. Similar trends were seen for both cancer- and cardiovascular mortality. The incidence of coronary disease and cancer did not differ across groups. Erythrocyte volume was an independent predictor of mortality, with the highest mortality observed for macrocytic anemia, which was less prevalent than microcytic and normocytic anemia. Dietary intake of iron and vitamin B12 were significantly lower and use of antithrombotic medications was significantly higher in subjects with anemia. The World Health Organisation definition of anemia was associated with increased mortality (hazard ratio 2.16) but excess mortality was also observed at higher hemoglobin levels. Of morphological subtypes, anemia with macrocytosis was rare but associated with the highest mortality.},
  author       = {Martinsson, Andreas and Andersson, Charlotte and Andell, Pontus and Koul, Sasha and Engström, Gunnar and Smith, Gustav},
  issn         = {1573-7284},
  language     = {eng},
  number       = {7},
  pages        = {489--498},
  publisher    = {Springer},
  series       = {European Journal of Epidemiology},
  title        = {Anemia in the general population: prevalence, clinical correlates and prognostic impact.},
  url          = {http://dx.doi.org/10.1007/s10654-014-9929-9},
  volume       = {29},
  year         = {2014},
}