[贫血增加老年人衰弱或残疾相关的死亡风险。FRADEA研究]
[Anemia increases mortality risk associated with frailty or disability in older adults. The FRADEA Study].
作者信息
Esquinas-Requena José Luis, Lozoya-Moreno Silvia, García-Nogueras Inmaculada, Atienzar-Núñez Pilar, Sánchez-Jurado Pedro Manuel, Abizanda Pedro
机构信息
Servicio de Geriatría, Hospital General Universitario de Ciudad Real, Ciudad Real, España.
Servicio de Geriatría, Complejo Hospitalario Universitario de Albacete, Albacete, España.
出版信息
Aten Primaria. 2020 Aug-Sep;52(7):452-461. doi: 10.1016/j.aprim.2019.07.001. Epub 2019 Sep 8.
OBJECTIVE
To analyze if anemia increases 10-year mortality risk associated to frailty and disability in older adults.
DESIGN
Substudy of the FRADEA population-based concurrent cohort study (Frailty and dependence in Albacete), with a 10-year follow-up (2007-2017) in people older than 69years.
SETTING
Albacete city, Spain.
PARTICIPANTS
Of the 993 participants included in the first wave, 790 were selected with valid data on function (frailty and disability), anemia and vital status at 10years.
MAIN MEASUREMENTS
Anemia was defined according to the criteria of the World Health Organization (hemoglobin <13g/dL in men and <12g/dL in women). A functional classification variable was created, including frailty and disability, identifying four progressive functional levels: robust, prefrail, frail and disabled in basic activities of daily life, using frailty phenotype and Barthel index respectively. A new eight categories variable was constructed combining the four functional groups with the presence or absence of anemia. The association with mortality was determined by Kaplan-Meier and Cox proportional hazards analysis adjusted for age, sex, comorbidity, polypharmacy, institutionalization and creatinine.
RESULTS
Mean age was 79years and 59.6% were women. 393 participants (49.7%) died during the follow-up period. The median survival was 98.4months (interquartile range 61). The risk of mortality increased from the levels with better functionality to those with worse functionality, and for each subgroup it was higher in the participants with anemia. Prefrail without anemia HR [hazard ratio] 1.59 (95%CI 1.07-2.36) and with anemia HR 2.37 (95%CI 1.38-4.05). Frail without anemia HR 3.18 (95%CI 1.68-6.02) and with anemia HR 4.42 (95%CI 1.99-9.84). Disabled without anemia HR 3.81 (95%CI 2.45-5.84) and with anemia HR 5.48 (95%CI 3.43-8.76).
CONCLUSION
Anemia increases the risk of mortality associated with frailty and disability in older adults.
目的
分析贫血是否会增加老年人10年中与衰弱和残疾相关的死亡风险。
设计
FRADEA基于人群的同期队列研究（阿尔瓦塞特的衰弱与依赖）的子研究，对69岁以上人群进行了为期10年的随访（2007 - 2017年）。
地点
西班牙阿尔瓦塞特市。
参与者
在第一波纳入的993名参与者中，790名在10年时具有关于功能（衰弱和残疾）、贫血及生命状态的有效数据。
主要测量指标
根据世界卫生组织标准定义贫血（男性血红蛋白<13g/dL，女性血红蛋白<12g/dL）。创建了一个功能分类变量，包括衰弱和残疾，分别使用衰弱表型和巴氏指数确定四个渐进的功能水平：强壮、衰弱前期、衰弱以及日常生活基本活动残疾。构建了一个新的八分类变量，将四个功能组与有无贫血情况相结合。通过Kaplan - Meier法和Cox比例风险分析确定与死亡率的关联，并对年龄、性别、合并症多药治疗、机构化和肌酐进行了校正。
结果
平均年龄为79岁，59.6%为女性。393名参与者（49.7%）在随访期间死亡。中位生存期为98.4个月（四分位间距61）。死亡率风险从功能较好的水平到功能较差的水平逐渐增加，并且对于每个亚组，贫血参与者的风险更高。衰弱前期无贫血者风险比（HR）为1.59（95%置信区间1.07 - 2.36），有贫血者HR为2.37（95%置信区间1.38 - 4.05）。衰弱无贫血者HR为3.18（95%置信区间1.68 - 6.02），有贫血者HR为4.42（95%置信区间1.99 - 9.84）。残疾无贫血者HR为3.81（95%置信区间2.45 - 5.84），有贫血者HR为5.48（95%置信区间3.43 - 8.76）。
结论
贫血会增加老年人与衰弱和残疾相关的死亡风险。
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