Association of anemia with health-related quality of life and survival: A large population-based cohort study

Anemia is highly prevalent, especially in older individuals. In selected populations, anemia has been reported to be associated with impaired survival and health-related quality of life. However, data on this impact in the general population are rare. Furthermore, discussions on the optimal definition of anemia have not been conclusive. We used survival data, scores from a health-related quality of life questionnaire (RAND-36), and hemoglobin concentration from 138670 subjects participating in the Lifelines cohort, aged 18-93 years. Anemia was defined according to World Health Organization criteria and was further classified in participants >60 years. Anemia was present in 5510 subjects (4.0%) of who 516 individuals older than 60 years were anemic (2.8%). Anemia had no impact on overall survival and limited impact on health-related quality of life in individuals 60 years anemia significantly impaired overall survival and health-related quality of life. The lower health-related quality of life was mainly observed in subscales representing physical functioning. Especially anemia of chronic inflammation was associated with worse overall survival and decreased health-related quality of life. Multivariate models confirmed that anemia was an independent risk factor for decreased health-related quality of life in older individuals. Finally, women with a hemoglobin concentration between 12.0-13.0 g/dL (considered anemia in men, but not in women) experienced a significantly lower health-related quality of life. This large prospective population-based study indicates that anemia is associated with worse overall survival and health-related quality of life in older individuals, but not in younger individuals. This study challenges the sex-dependent definition of anemia in individuals >60 years, and suggests that the optimal definition of anemia, in the perspective of health-related quality of life, in both men and women >60 years is a hemoglobin concentration