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Blood, 15 October 2004, Vol. 104, No. 8, pp. 2263-2268.
Prepublished online as a Blood First Edition Paper on July 6, 2004; DOI 10.1182/blood-2004-05-1812.
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CLINICAL OBSERVATIONS, INTERVENTIONS, AND THERAPEUTIC TRIALS
Prevalence of anemia in persons 65 years and older in the United States: evidence for a high rate of unexplained anemia
Jack M. Guralnik,
Richard S. Eisenstaedt,
Luigi Ferrucci,
Harvey G. Klein, and
Richard C. Woodman
From the Laboratory of Epidemiology, Demography, and Biometry, and the Longitudinal Studies Section, Clinical Research Branch, National Institute on Aging, Bethesda, MD; the Department of Internal Medicine, Temple University School of Medicine, Philadelphia, PA; the Department of Transfusion Medicine, Clinical Center, National Institutes of Health, Bethesda, MD; and Ortho Biotech Products LP, Bridgewater, NJ.
Clinicians frequently identify anemia in their older patients, but national data on the prevalence and causes of anemia in this population in the United States have been unavailable. Data presented here are from the noninstitutionalized US population assessed in the third National Health and Nutrition Examination Survey (1988-1994). Anemia was defined by World Health Organization criteria; causes of anemia included iron, folate, and B12 deficiencies, renal insufficiency, anemia of chronic inflammation (ACI), formerly termed anemia of chronic disease, and unexplained anemia (UA). ACI by definition required normal iron stores with low circulating iron (less than 60 µg/dL). After age 50 years, anemia prevalence rates rose rapidly, to a rate greater than 20% at age 85 and older. Overall, 11.0% of men and 10.2% of women 65 years and older were anemic. Of older persons with anemia, evidence of nutrient deficiency was present in one third, ACI or chronic renal disease or both was present in one third, and UA was present in one third. Most occurrences of anemia were mild; 2.8% of women and 1.6% of men had hemoglobin levels lower than 110 g/L (11 g/dL). Therefore, anemia is common, albeit not severe, in the older population, and a substantial proportion of anemia is of indeterminate cause. The impact of anemia on quality of life, recovery from illness, and functional abilities must be further investigated in older persons.
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