Anemia increases mortality risk associated with frailty or disability in older adults. The FRADEA Study

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 69 years. 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 10 years. Main measurements: Anemia was defined according to the criteria of the World Health Organization (hemoglobin < 13 g/dL in men and < 12 g/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 79 years and 59.6% were women. 393 participants (49.7%) died during the follow-up period. The median survival was 98.4 months (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. (C) 2019 The Authors. Published by Elsevier Espana, S.L.U.