Original Study
Cross-Sectional and Longitudinal Associations Between Anemia and Frailty in Older Australian Men: The Concord Health and Aging in Men Project

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Abstract

Background

Anemia and frailty are both common in older people and are associated with adverse health outcomes. There have been some cross-sectional studies of anemia and frailty but no longitudinal studies. The objectives of this study were to examine cross-sectional and longitudinal associations between anemia and frailty in older Australian men.

Methods

A total of 1666 men aged 70 years and older from the Concord Health and Aging in Men Project were assessed at baseline (2005–2007), 1314 men came for the 2-year follow-up between 2007 and 2009, and of those, 917 men returned for the 5-year follow-up between 2012 and 2013. The main outcome measurement was frailty, assessed using the Cardiovascular Health Study method. Anemia was defined as a hemoglobin levels <13.0 g/dL. Covariates included age, income, body mass index, measures of health, estimated glomerular filtration rate, and inflammatory markers (white cell count and albumin).

Results

The prevalence of anemia was 14.6% at baseline, 16.2% at 2-year follow-up, and 19.4% at 5-year follow-up. Prevalence of frailty was 9.1% at baseline and 9.7 % at both 2- and 5-year follow-up. Among men aged 70–74 at baseline, prevalence of frailty was 4.5%, but at 5-year follow-up the prevalence was 9.0%. There were significant cross-sectional associations between anemia and frailty in unadjusted [odds ratio, [OR 5.03 (95% confidence interval, CI 3.50, 7.25, P < .0001)] and in fully adjusted analysis [OR 2.90 (95% CI 1.87, 4.51, P < .0001)]. Generalized estimating equations time-lag models were used to examine the longitudinal associations between repeated measurements of hemoglobin and frailty. There were significant associations between measurements of anemia and frailty in unadjusted [OR 2.51 (95% CI 1.58, 4.00, P < .0001] and in fully adjusted analysis (OR 1.80, 95% CI 1.14, 2.85, P = .01).

Conclusions

Anemia was associated with frailty in both cross-sectional and longitudinal analyses, and anemia precedes frailty in men who were nonfrail at baseline. Low hemoglobin levels among patients may alert clinicians to the increased risk of frailty.

Section snippets

Study Participants

The Concord Health and Aging in Men Project (CHAMP) is an epidemiologic study of a wide range of health issues in Australian men aged 70 years and over.12 Participants in the CHAMP were recruited from a well-defined urban geographic region (the Local Government Areas of Burwood, Canada Bay and Strathfield) near Concord Hospital in Sydney, Australia. The sampling frame was the New South Wales Electoral Roll. Electoral registration is compulsory in Australia. The only exclusion criterion was

Baseline Characteristics of Participants

Characteristics of the analyzed sample are summarized in Table 1. A valid hemoglobin measure was obtained from 97.7% (1666) of the total sample of men (1705 men) who participated in the study at baseline. The mean (SD) hemoglobin concentration was 14.3 (1.3) g/dL. The mean age of the study population was 77 (range 70–97) years. Forty percent were aged between 70 and 74 years, 31% were between 75 and 79 years, 15% were between 80 and 85 years and 14% were aged above 85 years. Prevalence of

Discussion

In this large epidemiologic study, among community-dwelling older men, we show a high prevalence of both anemia and frailty among older community dwelling men. We demonstrate cross-sectional and longitudinal associations between anemia and frailty, even after full adjustment by confounders and covariates of clinical significance. There are only 2 other cross-sectional studies examining associations between anemia and frailty.10, 11 To our knowledge, our study is the first population-based

Conclusions

Our findings suggest that there might be a number of different biological mechanisms for how anemia might contribute to the frailty syndrome. Low hemoglobin levels among patients may alert clinicians to the increased risk of frailty.

Acknowledgments

The authors thank all the staff working on the CHAMP and the participants in the project. They would like to thank Dr Patrick Kelly for his statistical help.

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  • Cited by (0)

    The Concord Health and Aging in Men Project study is funded by the National Health and Medical Research Council (Grant no:301916) and the Aging and Alzheimer's Institute. The lead author is funded by the Australian Research Council Center of Excellence in Population Aging Research.

    The views expressed are those of the authors, not of the funders. Data analysis and interpretation were carried out by the authors independently of the funding sources based on the available data. The corresponding author had full access to the survey data.

    The funding body played no role in the formulation of the design, methods, subject recruitment, data collection, analysis, or preparation of this article.

    The authors declare no conflicts of interest.

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