Anemia is an independent predictor of increased overall mortality in older adults – results from the PolSenior study
6 affiliations
- 1Laboratory for Geriatric Medicine, Department of Palliative Medicine, Poznan University of Medical Sciences
- 2Health Promotion and Obesity Management Unit, Department of Pathophysiology, Faculty of Medical Sciences in Katowice, Medical University of Silesia in Katowice
- 3Department of Internal Medicine and Oncological Chemotherapy, Faculty of Medical Sciences in Katowice, Medical University of Silesia in Katowice
- 4International Institute of Molecular and Cell Biology
- 5Department of Internal Medicine and Gerontology Collegium Medicum of the Jagiellonian University in Krakow
- 6Department of Occupational Therapy, Poznan University of Medical Sciences
Abstract
Background: Although anemia in old age is traditionally viewed as a benign bystander of the aging process, its systemic impact on population health remains underestimated. This study evaluates the long-term health consequences of established hemoglobin concentration cut-off values by analyzing their independent impact on 10-year mortality and functional independence among community-dwelling older adults.
Participants and methods: 3,806 people aged 65 to 103 (1811 women, 1995 men) participated in the PolSenior project, a nationwide cross-sectional study with a 10-year prospective follow-up for mortality. We used ROC curve analysis to determine sex-specific hemoglobin cut-offs for mortality risk. Comprehensive geriatric assessments, including activities of daily living (ADLs/IADLs), cognitive status, nutritional risk, and inflammatory markers (IL-6, CRP), were analyzed across hemoglobin ranges using multivariable stepwise Cox proportional hazard regression stratified by age and renal function.
Results: During the 10-year follow-up period, 56.9% of the participants died. We established empirical hemoglobin cut-off values above which mortality increases sharply: 13.3 g/dL for women and 13.9 g/dL for men. Subgroups with results below these thresholds exhibited significantly higher mortality ( p < 0.001) and a higher incidence of dementia, depression, malnutrition, falls, and severe impairment in ADL/IADL. Multivariate analysis confirmed that the increased risk of death associated with low hemoglobin levels persisted independently of the presence of major chronic diseases and systemic inflammation.
Conclusion: This study provides the first nationwide evidence of distinct, sex-specific hemoglobin thresholds that independently influence long-term mortality and declines in functional ability. These findings highlight a key public health challenge: even a slight decrease in hemoglobin concentration represents a significant, modifiable risk factor for the loss of independence among the older adults. Public health strategies for healthy aging should incorporate proactive, community-based screening for anemia to delay the onset of disability and reduce the socioeconomic burden on aging healthcare systems.
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BibTeX
@article{styszynski2026anemia,
title = {{Anemia is an independent predictor of increased overall mortality in older adults – results from the PolSenior study}},
author = {Arkadiusz Styszyński and Aleksander J. Owczarek and Jerzy Chudek and Małgorzata Mossakowska and Alicja Klich-Rączka and Sławomir Tobis and Aleksandra Kaluźniak-Szymanowska and Beata Kaczmarek and Katarzyna Wieczorowska-Tobis},
journal = {Frontiers in Public Health},
year = {2026},
month = oct,
doi = {10.3389/fpubh.2026.1908528},
url = {https://www.frontiersin.org/articles/10.3389/fpubh.2026.1908528/full},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Anemia is an independent predictor of increased overall mortality in older adults – results from the PolSenior study
AU - Arkadiusz Styszyński
AU - Aleksander J. Owczarek
AU - Jerzy Chudek
AU - Małgorzata Mossakowska
AU - Alicja Klich-Rączka
AU - Sławomir Tobis
AU - Aleksandra Kaluźniak-Szymanowska
AU - Beata Kaczmarek
AU - Katarzyna Wieczorowska-Tobis
PY - 2026
DA - 2026/10/28
JO - Frontiers in Public Health
DO - 10.3389/fpubh.2026.1908528
UR - https://www.frontiersin.org/articles/10.3389/fpubh.2026.1908528/full
AB - Background: Although anemia in old age is traditionally viewed as a benign bystander of the aging process, its systemic impact on population health remains underestimated. This study evaluates the long-term health consequences of established hemoglobin concentration cut-off values by analyzing their independent impact on 10-year mortality and functional independence among community-dwelling older adults. Participants and methods: 3,806 people aged 65 to 103 (1811 women, 1995 men) participated in the PolSenior project, a nationwide cross-sectional study with a 10-year prospective follow-up for mortality. We used ROC curve analysis to determine sex-specific hemoglobin cut-offs for mortality risk. Comprehensive geriatric assessments, including activities of daily living (ADLs/IADLs), cognitive status, nutritional risk, and inflammatory markers (IL-6, CRP), were analyzed across hemoglobin ranges using multivariable stepwise Cox proportional hazard regression stratified by age and renal function. Results: During the 10-year follow-up period, 56.9% of the participants died. We established empirical hemoglobin cut-off values above which mortality increases sharply: 13.3 g/dL for women and 13.9 g/dL for men. Subgroups with results below these thresholds exhibited significantly higher mortality ( p < 0.001) and a higher incidence of dementia, depression, malnutrition, falls, and severe impairment in ADL/IADL. Multivariate analysis confirmed that the increased risk of death associated with low hemoglobin levels persisted independently of the presence of major chronic diseases and systemic inflammation. Conclusion: This study provides the first nationwide evidence of distinct, sex-specific hemoglobin thresholds that independently influence long-term mortality and declines in functional ability. These findings highlight a key public health challenge: even a slight decrease in hemoglobin concentration represents a significant, modifiable risk factor for the loss of independence among the older adults. Public health strategies for healthy aging should incorporate proactive, community-based screening for anemia to delay the onset of disability and reduce the socioeconomic burden on aging healthcare systems.
SN - 2296-2565
ER -