The combined effect of anemia and dynapenia on mortality risk in older adults: 10-Year evidence from the ELSA cohort study

Abstract

BACKGROUND/OBJECTIVE: Anemia and dynapenia can occur simultaneously. Separately, both conditions increase the mortality risk with advancing age. However, there is no epidemiological evidence on the combined effect of these conditions on mortality in older adults. We investigated whether combined anemia and dynapenia increase the mortality risk, and whether there are gender differences. METHODS: A 10-year follow-up study was conducted involving 5,310 older adults from the English Longitudinal Study of Ageing (ELSA). According to the diagnosis of anemia (hemoglobin concentration < 13.0 g/dL in men and < 12.0 g/dL in women) and dynapenia (grip strength < 26 kg for men and < 16 kg for women), individuals at baseline were categorized as "non-anemic/non-dynapenic", "dynapenic", "anemic" and "anemic/dynapenic". The outcome was all-cause mortality during the follow-up period. RESULTS: A total of 984 deaths were computed during the follow-up (63.7% in non-anemic/non-dynapenic, 22.8% in dynapenic, 7.5% in anemic and 6.0% in anemic/dynapenic). Adjusted Cox proportional hazard models stratified by sex showed that anemia and dynapenia combined was associated with an increased mortality risk in men (HR: 1.64; 95% IC 1.08 - 2.50) and women (HR: 2.17; 95% CI 1.44 - 3.26). Anemia in men (HR: 1.68; 95% CI 1.22 - 2.32) and dynapenia in women (HR: 1.37; 95% CI 1.09 - 1.72) were also risk factors for mortality. CONCLUSIONS: The coexistence of anemia and dynapenia increases the mortality risk, highlighting the need for early identification, prevention, and treatment of these conditions to reduce their complications and the mortality risk.