The definition of anemia in older persons

JAMA. 1999 May 12;281(18):1714-7. doi: 10.1001/jama.281.18.1714.


Context: Whether hemoglobin concentrations defined as anemia by the World Health Organization (WHO) are associated with increased mortality in older persons is not known.

Objective: To investigate the association between hemoglobin concentration and cause-specific mortality in older persons.

Design: Community-based study conducted from 1986 to 1996 (follow-up period, 10 years).

Setting: Leiden, the Netherlands.

Participants: A total of 1016 community residents aged 85 years and older were eligible and 872 agreed to have a blood sample taken. Hemoglobin concentration was measured in 755 persons (74%).

Main outcome measures: Hemoglobin concentration, 10-year survival, and primary cause of death. According to the WHO criteria, anemia was defined as a hemoglobin concentration below 7.5 mmol/L (120 g/L) in women and below 8.1 mmol/L (130 g/L) in men.

Results: Compared with persons with a normal hemoglobin concentration, the mortality risk was 1.60 (95% confidence interval [CI], 1.24-2.06; P<.001) in women with anemia, and 2.29 (95% CI, 1.60-3.26; P<.001) in men with anemia. In both sexes, the mortality risk increased with lower hemoglobin concentrations. In persons without self-reported clinical disease at baseline, the mortality risk of anemia was 2.21 (95% CI, 1.37-3.57; P=.002). Mortality from malignant and infectious diseases was higher in persons with anemia.

Conclusions: Anemia defined by the WHO criteria was associated with an increased mortality risk in persons aged 85 years and older. The criteria are thus appropriate for older persons. A low hemoglobin concentration at old age signifies disease.

Publication types

  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Aged
  • Aged, 80 and over
  • Anemia / blood
  • Anemia / mortality*
  • Cause of Death*
  • Female
  • Hemoglobins / analysis*
  • Humans
  • Male
  • Proportional Hazards Models
  • Risk
  • Survival Analysis


  • Hemoglobins