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. 2025 Sep 26;25(1):707.
doi: 10.1186/s12877-025-06353-2.

The prevalence and etiology of anemia and the association between anemia and all-cause mortality: a cohort study over a 9-year period

Yazhi Yang  1   2 , Hurong Lai  1 , Caifeng Liao  1 , Huijun Chen  2 , Xiaoyan Jiang  2 , Chuyang Lin  2 , Ling He  3 , Huaijun Tu  4 , Jian Li  5
Affiliations

The prevalence and etiology of anemia and the association between anemia and all-cause mortality: a cohort study over a 9-year period

Yazhi Yang et al. BMC Geriatr. .

Abstract

Research Background: As the global population ages rapidly, anemia prevalence rises among older adults, yet its impact on quality of life and mortality in this group remains poorly understood. This study aimed to identify risk factors for anemia and examine its associations with quality of life and 9-year all-cause mortality among Chinese adults aged ≥60.

Methods: We evaluated the determinants and consequences of anemia in 5,050 participants aged ≥ 60 from the China Health and Retirement Longitudinal Study (CHARLS), a prospective cohort of community-dwelling elderly individuals ≥ 45 at baseline and followed for up to 9 years. Anemia was defined according to the World Health Organization criteria. Multinomial logistic regression was performed to assess the correlation between anemia and aging. Cox proportional hazards models were used to evaluate the impact of anemia on all-cause mortality.

Results: In 2011, anemia prevalence was 15.05% (95% CI, 14.00–16.06%) and increased with age. Age (OR, 1.03; 95% CI, 1.01–1.05; P < 0.01), living in rural areas (OR, 1.51; 95% CI, 1.18–1.92; P < 0.01), and hypoproliferation ((OR, 1.43; 95% CI, 1.12–1.83; P < 0.01) were positively associated with anemia.Negative associations were observed for higher hematocrit (OR, 0.93; 95% CI, 0.91–0.95; P < 0.01) , total cholesterol (OR, 1.00; 95% CI, 0.99–1.00; P = 0.03), and the creatinine clearance rate (OR, 0.99; 95% CI, 0.98–1.00; P < 0.01). During the 9 years of follow-up, 741 of the 4767 (15.54%) participants died. After adjusting for covariates, anemia remained independently associated with mortality (HR, 1.22, 95% CI, 1.02, 1.47; P=0.03) was still closely associated with mortality. Persistent anemia significantly impaired survival, and anemia was linked to reduced quality of life.

Conclusion: This study revealed that anemia is prevalent among individuals aged ≥ 60 years in China and is related to age, residence type, hypoproliferation, hematocrit, total cholesterol and the creatinine clearance rate. Research has also confirmed that anemia is associated with worse overall survival in Chinese older adults.

Supplementary Information: The online version contains supplementary material available at 10.1186/s12877-025-06353-2.

Keywords: Anemia; Cohort; Elderly; Mortality; Quality of life; Risk factors.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: The China Health and Retirement Longitudinal Study (CHARLS) is a large interdisciplinary survey project that aims to collect a set of high-quality micro data representing families and individuals of middle-aged and elderly people aged ≥ 45 years in China to analyze the population aging problem in China. This study was approved by Peking University’s National School for Development (China Center for Economic Research) (PKU), and all the subjects provided informed consent. Verbal confirmation was acquired from illiterate participants, and their legal guardian signed the informed consent form. The research described in this publication was conducted in accordance with the Helsinki Declaration, and all procedures were carried out in accordance with applicable rules and regulations. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Study Schema: Participant Exclusion and Follow-up
Fig. 2
Fig. 2
The prevalence of anemia as a function of sex and age
Fig. 3
Fig. 3
Overall survival in individuals older than 60 years
Fig. 4
Fig. 4
Overall survival in individuals with no anemia, incident anemia or persistent anemia
See this image and copyright information in PMC

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