Targeted interventions needed to improve outcomes for certain patients with anemia
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Key takeaways:
- Factors associated with mortality included age, race, household income and hospital demographics.
- Researchers recommended the development of strategies to improve outcomes in anemia.
Anemia of chronic disease is associated with significant mortality, and overall outcomes are influenced by demographic, socioeconomic and hospital-related factors, according to study results presented at ASH Annual Meeting and Exposition.
The findings specifically showed that older patients and individuals with increased comorbidities experienced higher mortality, whereas women and Black individuals experienced decreased mortality upon hospital admissions for anemia of chronic disease.
Researchers noted a need for targeted interventions to improve outcomes among this patient population.
‘Backdrop’
“Anemia of chronic disease is the most common cause of anemia associated with hospitalizations. Recent estimates indicate that nearly 50% of all patients who are hospitalized are affected by anemia, with anemia of chronic disease accounting for approximately 40% of all documented anemia cases, and nearly 1 billion individuals are impacted globally,” Kalaivani Babu, MBBS, researcher at Allegheny General Hospital, Pittsburgh, told Healio. “In the inpatient setting, patients are often so acutely ill that hemoglobin levels are overlooked unless they fall below 7 g/dL, which is commonly used as the transfusion threshold. However, numerous studies have demonstrated that anemia of chronic disease can lead to worsened hospital outcomes, necessitating increased health care resource utilization and costs.”
Recent novel treatment approaches, including hypoxia-inducible factor stabilizers and prolyl hydroxylase enzyme inhibitors have shown promise by reducing hepcidin production, stimulating erythropoiesis and improving hemoglobin concentrations, Babu added.
“Given this backdrop, we aimed to quantify the health care burden imposed by anemia of chronic disease,” she said. “To achieve this, we analyzed patient data from the National Inpatient Sample database for the year 2021.”
The study included 2,007,019 hospitalizations (51.95% men; 54.01% white; 69.14% with public insurance). More than half (52.18%) received care in large hospitals and 77.51% in teaching hospitals.
Mortality data
Results showed an overall mortality rate for anemia of chronic disease of 5.11%.
Researchers observed a significant association between mortality and age (OR = 1.02; 95% 1.02-1.02), female sex (OR = 0.89; 95% CI, 0.86-0.91) and Black vs. white race (OR = 0.88; 95% CI, 0.84-0.92).
They also observed other significant risk factors associated with mortality, including median household income (2nd quartile OR = 0.94; 95% CI, 0.9-0.98; 3rd quartile OR = 0.9; 95% CI, 0.86-0.94; 4th quartile OR = 0.85; 95% CI, 0.8-0.9) and the Charlson Comorbidity Index (OR = 1.09; 95% CI, 1.08-1.1).
Further, they found an association between mortality and hospital region in the west (OR=1.17; 95% CI, 1.07-1.27), teaching status (OR = 0.99; 95% CI, 0.94-1.04), medium hospital bed size (OR = 1.08, 95% CI, 1-1.14) and large bed size (OR = 1.1; 95% CI, 1.03-1.17).
Mean hospital length of stay was 7.68 days. Results of adjusted regression analysis showed significant factors for length of hospital stay included age, female sex and hospital characteristics. Mean total hospitalization charges were $98,587.83, and significant factors associated with hospitalization charges included age, female sex and race, according to the researchers.
“Anemia of chronic disease was found to be prevalent across a wide population group, affecting patients of all backgrounds, with a predilection for older individuals,” Babu said. “Age was a major contributor, with a 2% increased risk for mortality for every additional year of age. Discrepancies were observed in the length of stay and hospitalization charges when comparing different regions in the U.S. and teaching vs. non-teaching hospitals. These findings highlight a lack of standardization in the care pathways for these patients, which has been repeatedly shown to lead to worsened outcomes.”
Babu said another significant finding was the increased risk for mortality among patients from ZIP codes in lower-income regions vs. those from “more affluent areas.”
“This disparity persisted even after adjusting for age, comorbidities, race and gender, raising concerns about whether substandard care or a lack of necessary resources in these regions contributes to these outcomes,” she said.
Additional research needs
Retrospective studies like the current study are valuable for identifying trends and associations; however, they do not establish causation, Babu told Healio.
“Moving forward, a detailed investigation into the factors driving regional and institutional variations in care, between teaching and non-teaching hospitals, is necessary,” she said. “Strategies should be developed to target elderly patients and those from lower-income regions to reduce disparities and improve outcomes.
“Additionally, analyzing resource utilization could help identify opportunities to optimize care delivery without compromising quality. Longitudinal studies would allow for a better understanding of trends in anemia of chronic disease outcomes over time. We are currently developing a detailed manuscript to evaluate these trends in patients with anemia of chronic disease further. We are excited to continue this work and uncover solutions to benefit patients with anemia of chronic disease.”
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Babu K, et al. Abstract 5023. Presented at: ASH Annual Meeting and Exposition; Dec. 7-10, 2024; San Diego.
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