Anaemia and the Risk of Injurious Falls in a Community-Dwelling Elderly Population
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Anaemia in the elderly is associated with a number of health-related functional declines, such as frailty, disability and muscle weakness. These may contribute to falls which, in the elderly, result in serious injuries in perhaps 10% of cases.
To investigate whether anaemia increases the risk of injurious falls in an elderly population.
Health insurance claims and laboratory test results data from January 1999 to April 2004 for 47 530 individuals ≥65 years of age enrolled in over 30 managed care plans were analysed. An open-cohort design was employed to classify patients’ observation periods by anaemia status (based on the WHO definition) and haemoglobin (Hb) level category. Injurious falls outcomes were defined as an injurious event claim, within 30 days after a fall claim, for fractures of the hip/pelvis/femur, vertebrae/ribs, humerus or lower limbs; Colles’ fracture; or head injuries/haematomas. Univariate and multivariate (adjusted for age, gender, health plan, history of falls, co-morbidities and concomitant medications) analyses were conducted. Subset analyses based on injurious falls of the hip and head were also conducted.
In the univariate analysis, anaemia increased the risk of injurious falls by 1.66 times (95% CI 1.41, 1.95) compared with no anaemia. The incidence of injurious falls increased from 6.5 to 15.8 per 1000 person-years when Hb levels decreased from ≥13 to <10g/dL (trend test: p< 0.001). Multivariate analysis confirmed that Hb levels were significantly associated with the risk of injurious falls (rate ratio = 1.47,1.39 and 1.14 for Hb levels of <10, 10–11.9 and 12–12.9 g/dL, respectively, compared with Hb ≥13 g/dL; p < 0.001). Even stronger linear negative trends were observed in the subsets of hip and head injurious falls.
Anaemia was significantly and independently associated with a risk increase for injurious falls. Furthermore, the risk of injurious falls increased as the degree of anaemia worsened. Correction of anaemia, a modifiable risk factor, warrants further investigation as a means of preventing falls in the elderly.
KeywordsRate Ratio Fall Event Anaemia Status Health Insurance Claim Injurious Fall
This research was funded by Ortho Biotech Clinical Affairs, LLC. The funding organization, through its co-authors on the study, contributed to the conception and design, acquisition of data, data analysis and interpretation, preparation of manuscript and final approval of the manuscript.
Mei Sheng Duh and Patrick Lefebvre are employees of Analysis Group, which has received research funds from Ortho Biotech Clinical Affairs, LLC in the past 5 years. Sharon Buteau was an employee of Analysis Group at the time of the study. Samir H. Mody is an employee of Ortho-McNeil Janssen and was an employee of Ortho Biotech Clinical Affairs, LLC at the time of the study. Catherine Tak Piech is an employee of Ortho Biotech Clinical Affairs, LLC. Samir H. Mody and Catherine Tak Piech hold stock and options in Johnson & Johnson. Richard C. Woodman is an employee of Novartis Pharmaceuticals and was an employee of Johnson & Johnson at the time of the study.
- 1.Chaves PHM, Ashar B, Guralnik JM, et al. Looking at the relationship between hemoglobin concentration and prevalent mobility difficulty in older women: should the criteria currently used to define anemia in older people be reevaluated? J Am Geriatr Soc 2002; 50(7): 1257–64PubMedCrossRefGoogle Scholar
- 3.National Center for Health Statistics. The Third National Health and Nutrition Survey (NHANES III, 1988–94) reference manuals and reports [online]. Available from URL: http://www.cdc.gov/nchs/about/major/nhanes/nh3rrm.htm [Accessed 2008 Mar 6]
- 7.National vital statistics reports [online]. Available from URL: http://www.cdc.gov/nchs/data/nvsr/nvsr52/nvsr52_21.pdf [Accessed 2006 Nov 9]
- 17.Logical Observation Identifiers Names and Codes (LOINC) classification [online]. Available from URL: http://www.regenstrief.org/medinformatics/loinc/ [Accessed 2008 Mar 6]