J Hematol

Journal of Hematology, ISSN 1927-1212 print, 1927-1220 online, Open Access

Article copyright, the authors; Journal compilation copyright, J Hematol and Elmer Press Inc

Journal website https://www.thejh.org

Original Article

Volume 10, Number 6, December 2021, pages 233-245

Impact of Correcting Nutritional Deficiency Anemias in the Elderly on Hospitalizations, Falls, and Mortalities

**Table 1.** Baseline Characteristics of All Patients
SD: standard deviation.
Age (years), mean (SD)	75.2 (7.8)
Gender
Male, n (%)	206 (34.3)
Female, n (%)	394 (65.7)
Race
White, n (%)	450 (75.0)
Black, n (%)	72 (12.0)
Hispanic, n (%)	29 (4.8)
Other, n (%)	49 (8.2)
Type of anemia
Iron deficiency, n (%)	74 (12.3)
Cobalamin deficiency, n (%)	92 (15.3)
Folate deficiency, n (%)	22 (3.7)
Anemia of chronic disease, n (%)	67 (11.2)
Myelodysplastic syndrome, n (%)	37 (6.2)
Renal insufficiency anemia, n (%)	34 (5.7)
Unexplained anemia, n (%)	274 (45.6)

Table 1. Baseline Characteristics of All Patients

SD: standard deviation.

Age (years), mean (SD)

75.2 (7.8)

Gender

Male, n (%)

206 (34.3)

Female, n (%)

394 (65.7)

Race

White, n (%)

450 (75.0)

Black, n (%)

72 (12.0)

Hispanic, n (%)

29 (4.8)

Other, n (%)

49 (8.2)

Type of anemia

Iron deficiency, n (%)

74 (12.3)

Cobalamin deficiency, n (%)

92 (15.3)

Folate deficiency, n (%)

22 (3.7)

Anemia of chronic disease, n (%)

67 (11.2)

Myelodysplastic syndrome, n (%)

37 (6.2)

Renal insufficiency anemia, n (%)

34 (5.7)

Unexplained anemia, n (%)

274 (45.6)

**Table 2.** Characteristics of Patients With Cobalamin Deficiency Anemia
Variable	CDA (n = 92)	NNDA (n = 412)	P
CDA: cobalamin deficiency anemia; NNDA: non-nutritional deficiency anemia; SD: standard deviation; CKD: chronic kidney disease; CHF: congestive heart failure; COPD: chronic obstructive pulmonary disease; CAD: coronary artery disease; Hb: hemoglobin; VKA: vitamin K antagonist; DOAC: direct oral anticoagulant.
Age, mean (SD)	76.6 (8.2)	74.3 (7.4)	0.008
BMI, mean (SD)	28.3 (5.52)	28.4 (6.0)	0.903
Gender
Male, n (%)	41 (44.6)	144 (35.0)	0.084
Female, n (%)	58 (71.9)	268 (65.0)
Race
White, n (%)	69 (75.1)	327 (79.9)	0.165
Black, n (%)	15 (16.3)	38 (9.1)
Hispanic, n (%)	4 (4.3)	16 (3.7)
Other, n (%)	4 (4.3)	31 (7.3)
Social factors
Cigarettes, n (%)	41 (44.5)	174 (42.2)	0.058
Alcohol, n (%)	45 (48.9)	184 (44.9)	0.483
Comorbidities
Number of comorbidities, mean (SD)	2.7 (1.8)	1.9 (1.4)	< 0.001
Diabetes mellitus, n (%)	27 (29.3)	100 (24.4)	0.329
Hypertension, n (%)	72 (78.3)	270 (65.9)	0.021
Hypothyroid, n (%)	26 (28.3)	94 (22.9)	0.278
CKD, n (%)	21 (22.8)	57 (13.9)	0.033
Malignancy	31 (33.7)	98 (23.7)	0.046
Rheumatologic disease, n (%)	12 (13.0)	47 (11.2)	0.104
Liver disease, n (%)	5 (5.4)	12 (2.7)	0.174
CHF, n (%)	12 (13.0)	23 (5.6)	0.011
COPD, n (%)	13 (14.1)	29 (7.1)	0.027
CAD, n (%)	29 (31.5)	75 (18.3)	0.005
Lab values
Hb < 8 g/dL, n (%)	0 (0.0)	2 (0.5)	< 0.001
Hb 8 - 10.9 g/dL, n (%)	12 (13.0)	21 (4.9)
Hb 11 - 13.9 g/dL, n (%)	64 (69.6)	229 (55.7)
Hb ≥ 14 g/dL, n (%)	16 (17.4)	160 (38.9)
Medications
Erythropoietin, n (%)	0 (0.0)	3 (0.7)	1.000
Aspirin, n (%)	45 (48.9)	163 (39.6)	0.102
Clopidogrel, n (%)	5 (5.4)	13 (3.2)	0.347
VKA, n (%)	6 (6.5)	14 (3.4)	0.232
DOAC, n (%)	9 (9.8)	32 (7.8)	0.536
Outcome
Hospitalization (median, 25th - 75th)	1 (0 - 2)	0 (0 - 1)	0.007
Fall (median, 25th - 75th)	0 (0 - 1)	0 (0 - 1)	0.171
Mortality, n (%)	7 (7.6)	14 (3.4)	0.083

Table 2. Characteristics of Patients With Cobalamin Deficiency Anemia

Variable

CDA (n = 92)

NNDA (n = 412)

CDA: cobalamin deficiency anemia; NNDA: non-nutritional deficiency anemia; SD: standard deviation; CKD: chronic kidney disease; CHF: congestive heart failure; COPD: chronic obstructive pulmonary disease; CAD: coronary artery disease; Hb: hemoglobin; VKA: vitamin K antagonist; DOAC: direct oral anticoagulant.

Age, mean (SD)

76.6 (8.2)

74.3 (7.4)

0.008

BMI, mean (SD)

28.3 (5.52)

28.4 (6.0)

0.903

Gender

Male, n (%)

41 (44.6)

144 (35.0)

0.084

Female, n (%)

58 (71.9)

268 (65.0)

Race

White, n (%)

69 (75.1)

327 (79.9)

0.165

Black, n (%)

15 (16.3)

38 (9.1)

Hispanic, n (%)

4 (4.3)

16 (3.7)

Other, n (%)

4 (4.3)

31 (7.3)

Social factors

Cigarettes, n (%)

41 (44.5)

174 (42.2)

0.058

Alcohol, n (%)

45 (48.9)

184 (44.9)

0.483

Comorbidities

Number of comorbidities, mean (SD)

2.7 (1.8)

1.9 (1.4)

< 0.001

Diabetes mellitus, n (%)

27 (29.3)

100 (24.4)

0.329

Hypertension, n (%)

72 (78.3)

270 (65.9)

0.021

Hypothyroid, n (%)

26 (28.3)

94 (22.9)

0.278

CKD, n (%)

21 (22.8)

57 (13.9)

0.033

Malignancy

31 (33.7)

98 (23.7)

0.046

Rheumatologic disease, n (%)

12 (13.0)

47 (11.2)

0.104

Liver disease, n (%)

5 (5.4)

12 (2.7)

0.174

CHF, n (%)

12 (13.0)

23 (5.6)

0.011

COPD, n (%)

13 (14.1)

29 (7.1)

0.027

CAD, n (%)

29 (31.5)

75 (18.3)

0.005

Lab values

Hb < 8 g/dL, n (%)

0 (0.0)

2 (0.5)

< 0.001

Hb 8 - 10.9 g/dL, n (%)

12 (13.0)

21 (4.9)

Hb 11 - 13.9 g/dL, n (%)

64 (69.6)

229 (55.7)

Hb ≥ 14 g/dL, n (%)

16 (17.4)

160 (38.9)

Medications

Erythropoietin, n (%)

0 (0.0)

3 (0.7)

1.000

Aspirin, n (%)

45 (48.9)

163 (39.6)

0.102

Clopidogrel, n (%)

5 (5.4)

13 (3.2)

0.347

VKA, n (%)

6 (6.5)

14 (3.4)

0.232

DOAC, n (%)

9 (9.8)

32 (7.8)

0.536

Outcome

Hospitalization (median, 25th - 75th)

1 (0 - 2)

0 (0 - 1)

0.007

Fall (median, 25th - 75th)

0 (0 - 1)

0.171

Mortality, n (%)

7 (7.6)

14 (3.4)

0.083

**Table 3.** Characteristics of Patients With Iron Deficiency Anemia
Variable	IDA (n = 74)	NNDA (n = 412)	P
IDA: iron deficiency anemia; NNDA: non-nutritional deficiency anemia; SD: standard deviation; CKD: chronic kidney disease; CHF: congestive heart failure; COPD: chronic obstructive pulmonary disease; CAD: coronary artery disease; Hb: hemoglobin; VKA: vitamin K antagonist; DOAC: direct oral anticoagulant.
Age, mean (SD)	78.2 (8.6)	74.3 (7.4)	< 0.001
BMI, mean (SD)	28.2 (6.2)	28.4 (6.0)	0.769
Gender
Male, n (%)	17 (23.0)	144 (35.0)	0.044
Female, n (%)	57 (77.0)	268 (65.0)
Race
White, n (%)	54 (73.0)	327 (79.9)	0.374
Black, n (%)	10 (13.4)	38 (9.1)
Hispanic, n (%)	5 (6.8)	16 (3.7)
Other, n (%)	5 (6.8)	31 (7.3)
Social factors
Cigarettes, n (%)	28 (37.8)	174 (42.2)	0.122
Alcohol, n (%)	18 (24.3)	184 (44.9)	< 0.001
Comorbidities
Number of comorbidities, mean (SD)	2.7 (1.6)	1.9 (1.4)	< 0.001
Diabetes mellitus, n (%)	25 (33.8)	100 (24.4)	0.092
Hypertension, n (%)	60 (81.1)	270 (65.9)	0.010
Hypothyroid, n (%)	13 (17.6)	94 (22.9)	0.307
CKD, n (%)	24 (32.4)	57 (13.9)	< 0.001
Malignancy	24 (32.4)	98 (23.7)	0.109
Rheumatologic disease, n (%)	10 (13.5)	47 (11.2)	0.570
Liver disease, n (%)	5 (6.8)	12 (2.7)	0.081
CHF, n (%)	15 (20.3)	24 (5.6)	< 0.001
COPD, n (%)	9 (12.2)	29 (7.1)	0.134
CAD, n (%)	14 (18.9)	75 (18.3)	0.898
Lab values
Hb < 8 g/dL, n (%)	2 (2.7)	2 (0.5)	< 0.001
Hb 8 - 10.9 g/dL, n (%)	24 (32.4)	21 (4.9)
Hb 11 - 13.9 g/dL, n (%)	46 (62.2)	229 (55.7)
Hb ≥ 14 g/dL, n (%)	2 (2.7)	160 (38.9)
Medications
Erythropoietin, n (%)	3 (4.1)	3 (0.7)	0.049
Aspirin, n (%)	29 (39.2)	163 (39.6)	0.946
Clopidogrel, n (%)	5 (6.8)	13 (3.2)	0.172
VKA, n (%)	1 (1.4)	14 (3.4)	0.486
DOAC, n (%)	7 (9.5)	32 (7.8)	0.635
Outcome
Hospitalization, median (25th - 75th)	2 (0 - 4)	0 (0 - 1)	< 0.001
Fall, median (25th - 75th)	1 (0 - 3)	0 (0 - 1)	< 0.001
Mortality, n (%)	8 (10.8)	14 (3.4)	0.011

Table 3. Characteristics of Patients With Iron Deficiency Anemia

Variable

IDA (n = 74)

NNDA (n = 412)

IDA: iron deficiency anemia; NNDA: non-nutritional deficiency anemia; SD: standard deviation; CKD: chronic kidney disease; CHF: congestive heart failure; COPD: chronic obstructive pulmonary disease; CAD: coronary artery disease; Hb: hemoglobin; VKA: vitamin K antagonist; DOAC: direct oral anticoagulant.

Age, mean (SD)

78.2 (8.6)

74.3 (7.4)

< 0.001

BMI, mean (SD)

28.2 (6.2)

28.4 (6.0)

0.769

Gender

Male, n (%)

17 (23.0)

144 (35.0)

0.044

Female, n (%)

57 (77.0)

268 (65.0)

Race

White, n (%)

54 (73.0)

327 (79.9)

0.374

Black, n (%)

10 (13.4)

38 (9.1)

Hispanic, n (%)

5 (6.8)

16 (3.7)

Other, n (%)

5 (6.8)

31 (7.3)

Social factors

Cigarettes, n (%)

28 (37.8)

174 (42.2)

0.122

Alcohol, n (%)

18 (24.3)

184 (44.9)

< 0.001

Comorbidities

Number of comorbidities, mean (SD)

2.7 (1.6)

1.9 (1.4)

< 0.001

Diabetes mellitus, n (%)

25 (33.8)

100 (24.4)

0.092

Hypertension, n (%)

60 (81.1)

270 (65.9)

0.010

Hypothyroid, n (%)

13 (17.6)

94 (22.9)

0.307

CKD, n (%)

24 (32.4)

57 (13.9)

< 0.001

Malignancy

24 (32.4)

98 (23.7)

0.109

Rheumatologic disease, n (%)

10 (13.5)

47 (11.2)

0.570

Liver disease, n (%)

5 (6.8)

12 (2.7)

0.081

CHF, n (%)

15 (20.3)

24 (5.6)

< 0.001

COPD, n (%)

9 (12.2)

29 (7.1)

0.134

CAD, n (%)

14 (18.9)

75 (18.3)

0.898

Lab values

Hb < 8 g/dL, n (%)

2 (2.7)

2 (0.5)

< 0.001

Hb 8 - 10.9 g/dL, n (%)

24 (32.4)

21 (4.9)

Hb 11 - 13.9 g/dL, n (%)

46 (62.2)

229 (55.7)

Hb ≥ 14 g/dL, n (%)

2 (2.7)

160 (38.9)

Medications

Erythropoietin, n (%)

3 (4.1)

3 (0.7)

0.049

Aspirin, n (%)

29 (39.2)

163 (39.6)

0.946

Clopidogrel, n (%)

5 (6.8)

13 (3.2)

0.172

VKA, n (%)

1 (1.4)

14 (3.4)

0.486

DOAC, n (%)

7 (9.5)

32 (7.8)

0.635

Outcome

Hospitalization, median (25th - 75th)

2 (0 - 4)

0 (0 - 1)

< 0.001

Fall, median (25th - 75th)

1 (0 - 3)

0 (0 - 1)

< 0.001

Mortality, n (%)

8 (10.8)

14 (3.4)

0.011

**Table 4.** Characteristics of Patients With Folate Deficiency Anemia
Variable	FDA (n = 22)	NNDA (n = 412)	P
FDA: folate deficiency anemia; NNDA: non-nutritional deficiency anemia; SD: standard deviation; CKD: chronic kidney disease; CHF: congestive heart failure; COPD: chronic obstructive pulmonary disease; CAD: coronary artery disease; Hb: hemoglobin; VKA: vitamin K antagonist; DOAC: direct oral anticoagulant.
Age, mean (SD)	77.2 (7.6)	74.3 (7.4)	0.073
BMI, mean (SD)	29.9 (5.4)	28.4 (6.0)	0.257
Gender
Male, n (%)	4 (18.2)	144 (35.0)	0.106
Female, n (%)	18 (81.8)	268 (65.0)
Race
White, n (%)	16 (72.7)	327 (79.9)	0.163
Black, n (%)	4 (18.2)	38 (9.1)
Hispanic, n (%)	2 (9.1)	16 (3.7)
Other, n (%)	0 (0.0)	31 (7.3)
Social factors
Cigarettes, n (%)	11 (50.0)	174 (42.2)	0.731
Alcohol, n (%)	9 (40.9)	184 (44.9)	0.715
Comorbidities
Number of comorbidities, mean (SD)	2.1 (0.9)	1.9 (1.4)	0.535
Diabetes mellitus, n (%)	5 (22.7)	100 (24.4)	0.885
Hypertension, n (%)	15 (68.2)	270 (65.9)	0.822
Hypothyroid, n (%)	6 (27.3)	94 (22.9)	0.638
CKD, n (%)	1 (4.5)	57 (13.9)	0.336
Malignancy	7 (31.8)	98 (23.7)	0.383
Rheumatologic disease, n (%)	2 (9.1)	47 (11.2)	1.000
Liver disease, n (%)	2 (9.1)	12 (2.7)	0.137
CHF, n (%)	1 (4.5)	23 (5.6)	1.000
COPD, n (%)	3 (13.6)	29 (7.1)	0.217
CAD, n (%)	4 (18.2)	75 (18.3)	1.000
Lab values
Hb < 8 g/dL, n (%)	0 (0.0)	2 (0.5)	0.298
Hb 8 - 10.9 g/dL, n (%)	1 (4.5)	21 (4.9)
Hb 11 - 13.9 g/dL, n (%)	8 (36.4)	229 (55.7)
Hb ≥ 14 g/dL, n (%)	13 (59.1)	160 (38.9)
Medications
Erythropoietin, n (%)	0 (0.0)	3 (0.7)	1.000
Aspirin, n (%)	10 (45.5)	163 (39.6)	0.585
Clopidogrel, n (%)	1 (4.5)	13 (3.2)	0.525
VKA, n (%)	2 (9.1)	14 (3.4)	0.194
DOAC, n (%)	0 (0.0)	32 (7.8)	0.393
Outcome
Hospitalization, median (25th - 75th)	1 (0 - 2)	0 (0 - 1)	0.001
Fall, median (25th - 75th)	0 (0 - 1)	0 (0 - 1)	0.615
Mortality, n (%)	1 (4.5)	14 (3.4)	0.550

Table 4. Characteristics of Patients With Folate Deficiency Anemia

Variable

FDA (n = 22)

NNDA (n = 412)

FDA: folate deficiency anemia; NNDA: non-nutritional deficiency anemia; SD: standard deviation; CKD: chronic kidney disease; CHF: congestive heart failure; COPD: chronic obstructive pulmonary disease; CAD: coronary artery disease; Hb: hemoglobin; VKA: vitamin K antagonist; DOAC: direct oral anticoagulant.

Age, mean (SD)

77.2 (7.6)

74.3 (7.4)

0.073

BMI, mean (SD)

29.9 (5.4)

28.4 (6.0)

0.257

Gender

Male, n (%)

4 (18.2)

144 (35.0)

0.106

Female, n (%)

18 (81.8)

268 (65.0)

Race

White, n (%)

16 (72.7)

327 (79.9)

0.163

Black, n (%)

4 (18.2)

38 (9.1)

Hispanic, n (%)

2 (9.1)

16 (3.7)

Other, n (%)

0 (0.0)

31 (7.3)

Social factors

Cigarettes, n (%)

11 (50.0)

174 (42.2)

0.731

Alcohol, n (%)

9 (40.9)

184 (44.9)

0.715

Comorbidities

Number of comorbidities, mean (SD)

2.1 (0.9)

1.9 (1.4)

0.535

Diabetes mellitus, n (%)

5 (22.7)

100 (24.4)

0.885

Hypertension, n (%)

15 (68.2)

270 (65.9)

0.822

Hypothyroid, n (%)

6 (27.3)

94 (22.9)

0.638

CKD, n (%)

1 (4.5)

57 (13.9)

0.336

Malignancy

7 (31.8)

98 (23.7)

0.383

Rheumatologic disease, n (%)

2 (9.1)

47 (11.2)

1.000

Liver disease, n (%)

2 (9.1)

12 (2.7)

0.137

CHF, n (%)

1 (4.5)

23 (5.6)

1.000

COPD, n (%)

3 (13.6)

29 (7.1)

0.217

CAD, n (%)

4 (18.2)

75 (18.3)

1.000

Lab values

Hb < 8 g/dL, n (%)

0 (0.0)

2 (0.5)

0.298

Hb 8 - 10.9 g/dL, n (%)

1 (4.5)

21 (4.9)

Hb 11 - 13.9 g/dL, n (%)

8 (36.4)

229 (55.7)

Hb ≥ 14 g/dL, n (%)

13 (59.1)

160 (38.9)

Medications

Erythropoietin, n (%)

0 (0.0)

3 (0.7)

1.000

Aspirin, n (%)

10 (45.5)

163 (39.6)

0.585

Clopidogrel, n (%)

1 (4.5)

13 (3.2)

0.525

VKA, n (%)

2 (9.1)

14 (3.4)

0.194

DOAC, n (%)

0 (0.0)

32 (7.8)

0.393

Outcome

Hospitalization, median (25th - 75th)

1 (0 - 2)

0 (0 - 1)

0.001

Fall, median (25th - 75th)

0 (0 - 1)

0.615

Mortality, n (%)

1 (4.5)

14 (3.4)

0.550

**Table 5.** Adverse Health Outcomes in Nutritional Deficiency Anemias and Non-Nutritional Deficiency Anemias
Outcome	CDA (n = 92)	IDA (n = 74)	FDA (n = 22)	NNDA (n = 412)
CDA: cobalamin deficiency anemia; IDA: iron deficiency anemia; FDA: folate deficiency anemia; NNDA: non-nutritional deficiency anemia.
Hospitalizations, median (25th - 75th)	1 (0 - 2)	2 (0 - 4)	1 (0 - 2)	0 (0 - 1)
Falls, median (25th - 75th)	0 (0 - 1)	1 (0 - 3)	0 (0 - 1)	0 (0 - 1)
Mortality, n (%)	7 (7.6)	8 (10.8)	1 (4.5)	14 (3.4)

Table 5. Adverse Health Outcomes in Nutritional Deficiency Anemias and Non-Nutritional Deficiency Anemias

Outcome

CDA (n = 92)

IDA (n = 74)

FDA (n = 22)

NNDA (n = 412)

CDA: cobalamin deficiency anemia; IDA: iron deficiency anemia; FDA: folate deficiency anemia; NNDA: non-nutritional deficiency anemia.

Hospitalizations, median (25th - 75th)

1 (0 - 2)

2 (0 - 4)

1 (0 - 2)

0 (0 - 1)

Falls, median (25th - 75th)

0 (0 - 1)

1 (0 - 3)

0 (0 - 1)

Mortality, n (%)

7 (7.6)

8 (10.8)

1 (4.5)

14 (3.4)

**Table 6.** Logistic Regression Model of Adverse Health Outcomes in Nutritional Deficiency Anemias Versus Non-Nutritional Deficiency Anemias
Variable	B	P	Exp(B)	95% CI for Exp(B)
CDA: cobalamin deficiency anemia; NNDA: non-nutritional deficiency anemia; IDA: iron deficiency anemia; FDA: folate deficiency anemia.
Hospitalization CDA vs. NNDA	0.193	0.015	1.213	0.734	2.005
Hospitalization IDA vs. NNDA	0.889	0.002	2.432	1.381	4.281
Hospitalization FDA vs. NNDA	1.390	0.007	4.015	1.470	10.966
Falls CDA vs. NNDA	0.526	0.058	1.693	1.030	2.783
Falls IDA vs. NNDA	0.949	0.001	2.584	1.512	4.416
Falls FDA vs. NNDA	0.115	0.813	1.121	0.434	2.899
Mortality CDA vs. NNDA	0.306	0.572	1.358	0.469	3.933
Mortality IDA vs. NNDA	0.216	0.009	1.240	0.416	3.702
Mortality FDA vs. NNDA	0.163	0.882	1.177	0.137	10.102

Table 6. Logistic Regression Model of Adverse Health Outcomes in Nutritional Deficiency Anemias Versus Non-Nutritional Deficiency Anemias

Variable

Exp(B)

95% CI for Exp(B)

Lower

Upper

CDA: cobalamin deficiency anemia; NNDA: non-nutritional deficiency anemia; IDA: iron deficiency anemia; FDA: folate deficiency anemia.

Hospitalization CDA vs. NNDA

0.193

0.015

1.213

0.734

2.005

Hospitalization IDA vs. NNDA

0.889

0.002

2.432

1.381

4.281

Hospitalization FDA vs. NNDA

1.390

0.007

4.015

1.470

10.966

Falls CDA vs. NNDA

0.526

0.058

1.693

1.030

2.783

Falls IDA vs. NNDA

0.949

0.001

2.584

1.512

4.416

Falls FDA vs. NNDA

0.115

0.813

1.121

0.434

2.899

Mortality CDA vs. NNDA

0.306

0.572

1.358

0.469

3.933

Mortality IDA vs. NNDA

0.216

0.009

1.240

0.416

3.702

Mortality FDA vs. NNDA

0.163

0.882

1.177

0.137

10.102