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Анемия и коморбидность у лиц старше 65 лет: данные российского исследования ЭВКАЛИПТ - Журнал Терапевтический архив №4 Вопросы диагностики внутренних болезней 2025
Анемия и коморбидность у лиц старше 65 лет: данные российского исследования ЭВКАЛИПТ
Ховасова Н.О., Воробьёва Н.М., Наумов А.В., Малая И.П., Котовская Ю.В., Ткачёва О.Н. Анемия и коморбидность у лиц старше 65 лет: данные российского исследования ЭВКАЛИПТ. Терапевтический архив. 2025;97(4):336–343. DOI: 10.26442/00403660.2025.04.203197
© ООО «КОНСИЛИУМ МЕДИКУМ», 2025 г.
© ООО «КОНСИЛИУМ МЕДИКУМ», 2025 г.
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Аннотация
Обоснование. Анемия представляет собой существенную составляющую коморбидной патологии, одновременно являясь осложнением соматических заболеваний и фактором их прогрессирования. Коморбидные пациенты с низким гемоглобином имеют большее количество заболеваний, худшие параметры гериатрического статуса и самую низкую выживаемость. Особенно негативные последствия снижения гемоглобина отмечены у лиц старшей возрастной группы.
Цель. Изучить взаимосвязи между анемией и коморбидностью у пациентов в возрасте 65 лет и старше.
Материалы и методы. Представлены результаты субанализа многоцентрового одномоментного поперечного исследования ЭВКАЛИПТ, в котором участвовали 4308 человек, из них 30% – мужчины, в возрасте 65–107 лет (средний возраст – 78 лет). Оценивали коморбидную патологию и подсчитывали индекс коморбидности Charlson, изучали общий анализ крови.
Результаты. Частота коморбидной патологии составила 89%, анемии – 24%. Значение индекса коморбидности Charlson у пациентов с анемией было больше, чем у лиц без анемии – 5 (4; 7) против 4 (3; 6) баллов (р<0,001). При увеличении значений индекса Charlson на каждый 1 балл шансы иметь анемию возрастают на 21% (отношение шансов 1,21; 95% доверительный интервал 1,17–1,25; р<0,001). Многофакторный регрессионный анализ позволил идентифицировать 9 независимых предикторов наличия анемии (возраст ≥82 лет, мужской пол, инфаркт миокарда и инсульт в анамнезе, язвенную болезнь желудка, фибрилляцию предсердий, хроническую болезнь почек IV и V стадии, активное онкологическое заболевание, отсутствие артериальной гипертензии) с отношением шансов 1,25–3,14. При наличии 2–4 предикторов риск анемии увеличивается в 1,3–2,6 раза, 5 предикторов – почти в 5 раз, 6 и более – почти в 13 раз.
Заключение. Коморбидные пациенты являются группой риска по развитию анемии, что требует своевременного лечения, в том числе препаратами железа, в случае подтверждения абсолютного или функционального дефицита железа.
Ключевые слова: анемия, коморбидность, коморбидные заболевания, пожилой возраст, индекс коморбидности Charlson
Aim. To investigate the relationship between anemia and comorbidity in patients aged 65 years and older.
Materials and methods. The results of a sub-analysis of the multicenter cross-sectional study EUCALYPTUS, which involved 4308 people (30% of men) aged 65 to 107 years (average age – 78 years), are presented. The comorbidity was assessed and the Charlson comorbidity index was calculated, and the complete blood count was studied.
Results. The frequency of comorbidity was 89%, anemia – 24%. The value of the Charlson comorbidity index in patients with anemia was greater than in those without anemia – 5 (4; 7) vs. 4 (3; 6) points (p<0.001). For every 1-point increase in Charlson index values, the odds of having anemia increase by 21% (odds ratio 1.21; 95% confidence interval 1.17–1.25; p<0.001). Multivariate regression analysis identified 9 independent predictors of anemia (age ≥82 years, male, history of myocardial infarction and stroke, peptic ulcer disease, atrial fibrillation, stage 4 and 5 chronic kidney disease, active cancer, no hypertension) with an odds ratio of 1.25 to 3.14. In the presence of 2–4 predictors, the risk of anemia increases 1.3–2.6 times, 5 predictors – almost 5 times, 6 or more – almost 13 times.
Conclusion. Comorbidity patients are at risk for the development of anemia, which requires timely treatment, including iron supplements if absolute or functional iron deficiency is confirmed.
Keywords: anemia, comorbidity, comorbid diseases, advanced age, Charlson comorbidity index
Цель. Изучить взаимосвязи между анемией и коморбидностью у пациентов в возрасте 65 лет и старше.
Материалы и методы. Представлены результаты субанализа многоцентрового одномоментного поперечного исследования ЭВКАЛИПТ, в котором участвовали 4308 человек, из них 30% – мужчины, в возрасте 65–107 лет (средний возраст – 78 лет). Оценивали коморбидную патологию и подсчитывали индекс коморбидности Charlson, изучали общий анализ крови.
Результаты. Частота коморбидной патологии составила 89%, анемии – 24%. Значение индекса коморбидности Charlson у пациентов с анемией было больше, чем у лиц без анемии – 5 (4; 7) против 4 (3; 6) баллов (р<0,001). При увеличении значений индекса Charlson на каждый 1 балл шансы иметь анемию возрастают на 21% (отношение шансов 1,21; 95% доверительный интервал 1,17–1,25; р<0,001). Многофакторный регрессионный анализ позволил идентифицировать 9 независимых предикторов наличия анемии (возраст ≥82 лет, мужской пол, инфаркт миокарда и инсульт в анамнезе, язвенную болезнь желудка, фибрилляцию предсердий, хроническую болезнь почек IV и V стадии, активное онкологическое заболевание, отсутствие артериальной гипертензии) с отношением шансов 1,25–3,14. При наличии 2–4 предикторов риск анемии увеличивается в 1,3–2,6 раза, 5 предикторов – почти в 5 раз, 6 и более – почти в 13 раз.
Заключение. Коморбидные пациенты являются группой риска по развитию анемии, что требует своевременного лечения, в том числе препаратами железа, в случае подтверждения абсолютного или функционального дефицита железа.
Ключевые слова: анемия, коморбидность, коморбидные заболевания, пожилой возраст, индекс коморбидности Charlson
________________________________________________
Aim. To investigate the relationship between anemia and comorbidity in patients aged 65 years and older.
Materials and methods. The results of a sub-analysis of the multicenter cross-sectional study EUCALYPTUS, which involved 4308 people (30% of men) aged 65 to 107 years (average age – 78 years), are presented. The comorbidity was assessed and the Charlson comorbidity index was calculated, and the complete blood count was studied.
Results. The frequency of comorbidity was 89%, anemia – 24%. The value of the Charlson comorbidity index in patients with anemia was greater than in those without anemia – 5 (4; 7) vs. 4 (3; 6) points (p<0.001). For every 1-point increase in Charlson index values, the odds of having anemia increase by 21% (odds ratio 1.21; 95% confidence interval 1.17–1.25; p<0.001). Multivariate regression analysis identified 9 independent predictors of anemia (age ≥82 years, male, history of myocardial infarction and stroke, peptic ulcer disease, atrial fibrillation, stage 4 and 5 chronic kidney disease, active cancer, no hypertension) with an odds ratio of 1.25 to 3.14. In the presence of 2–4 predictors, the risk of anemia increases 1.3–2.6 times, 5 predictors – almost 5 times, 6 or more – almost 13 times.
Conclusion. Comorbidity patients are at risk for the development of anemia, which requires timely treatment, including iron supplements if absolute or functional iron deficiency is confirmed.
Keywords: anemia, comorbidity, comorbid diseases, advanced age, Charlson comorbidity index
Полный текст
Список литературы
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2. Nguyen H, Manolova G, Daskalopoulou C, et al. Prevalence of multimorbidity in community settings: A systematic review and meta-analysis of observational studies. J Comorb. 2019;9:2235042X19870934. DOI:10.1177/2235042X19870934
3. Chowdhury SR, Chandra Das D, Sunna TC, et al. Global and regional prevalence of multimorbidity in the adult population in community settings: a systematic review and meta-analysis. EClinicalMedicine. 2023;57:101860. DOI:10.1016/j.eclinm.2023.101860
4. Zhong Y, Xi H, Guo X, et al. Gender and Socioeconomic Differences in the Prevalence and Patterns of Multimorbidity among Middle-Aged and Older Adults in China. Int J Environ Res Public Health. 2022;19(24). DOI:10.3390/ijerph192416956
5. Stieglitz LM, Bärnighausen T, Leyna GH, et al. Patterns of comorbidity and multimorbidity among middle-aged and elderly women in peri-urban Tanzania. J Multimorb Comorb. 2022;12:26335565221076254. DOI:10.1177/26335565221076254
6. Kuan V, Denaxas S, Patalay P, et al. Identifying and visualising multimorbidity and comorbidity patterns in patients in the English National Health Service: a population-based study. Lancet Digit Health. 2023;5(1):e16-27. DOI:10.1016/S2589-7500(22)00187-X
7. Kohler S, Bärnighausen T, Kazonda P, et al. Chronic Conditions and Multimorbidity Among Middle-Aged and Elderly Peri-Urban Dwellers in Dar es Salaam, Tanzania. Int J Public Health. 2024;69:1606387. DOI:10.3389/ijph.2024.1606387
8. Han S, Li S, Yang Y, et al. Mapping multimorbidity progression among 190 diseases. Commun Med (Lond). 2024;4(1):139. DOI:10.1038/s43856-024-00563-2
9. Haemoglobin concentrations for the diagnosis of anaemia and assessment of severity. World Health Organization, 2011. No. WHO/NMH/NHD/MNM/11.1. Available at: https://www.who.int/publications/i/item/WHO-NMH-NHD-MNM-11.1. Accessed: 20.02.2025.
10. Roso-Llorach A, Vetrano DL, Trevisan C, et al. 12-year evolution of multimorbidity patterns among older adults based on Hidden Markov Models. Aging (Albany NY). 2022;14(24):9805-87. DOI:10.18632/aging.204395
11. Marengoni A, Tazzeo C, Calderón-Larrañaga A, et al. Multimorbidity Patterns and 6-Year Risk of Institutionalization in Older Persons: The Role of Social Formal and Informal Care. J Am Med Dir Assoc. 2021;22(10):2184-9.e1. DOI:10.1016/j.jamda.2020.12.040
12. Akugizibwe R, Calderón-Larrañaga A, Roso-Llorach A, et al. Multimorbidity Patterns and Unplanned Hospitalisation in a Cohort of Older Adults. J Clin Med. 2020;9(12):4001. DOI:10.3390/jcm9124001
13. Vorobyeva NM, Tkacheva ON, Kotovskaya YuV, et al. Russian epidemiological study EVKALIPT: protocol and basic characteristics of participants. Russian Journal of Geriatric Medicine. 2021;1(5):35-43 (in Russian). DOI:10.37586/2686-8636-1-2021-35-43
14. Vertkin AL. Comorbidity: history, recent views, prevention and treatment. Cardiovascular Therapy and Prevention. 2015;14(2):74-9 (in Russian). DOI:10.15829/1728-8800-2015-2-74-79
15. Garin N, Koyanagi A, Chatterji S, et al. Global Multimorbidity Patterns: A Cross-Sectional, Population-Based, Multi-Country Study. J Gerontol A Biol Sci Med Sci. 2016;71(2):205-14. DOI:10.1093/gerona/glv128
16. Khovasova NO, Vorobieva NM, Naumov AV, Tkacheva ON. Effect of Anemia on 5-Year Survival Rates of Senile People and Centenarians. Lechebnoe delo. 2022;2:100-9 (in Russian). DOI:10.24412/2071-5315-2022-12812
17. Girelli D, Marchi G, Camaschella C. Anemia in the Elderly. Hemasphere. 2018;2(3):e40. DOI:10.1097/HS9.0000000000000040
18. Wouters HJCM, van der Klauw MM, de Witte T, et al. Association of anemia with health-related quality of life and survival: a large population-based cohort study. Haematologica. 2019;104(3):468-76. DOI:10.3324/haematol.2018.195552
19. Clancy CC, Browne LD, Gilligan R, et al. Prevalence of anaemia, iron, and vitamin deficiencies in the health system in the Republic of Ireland: a retrospective cohort study. BJGP Open. 2023;8(2):BJGPO.2023.0126. DOI:10.3399/bjgpo.2023.0126
20. Gandhi SJ, Hagans I, Nathan K, et al. Prevalence, Comorbidity and Investigation of Anemia in the Primary Care Office. J Clin Med Res. 2017;9(12):970-80. DOI:10.14740/jocmr3221w
21. Chueh HW, Jung HL, Shim YJ, et al. High anemia prevalence in Korean older adults, an advent healthcare problem: 2007–2016 KNHANES. BMC Geriatr. 2020;20(1):509. DOI:10.1186/s12877-020-01918-9
22. Khovasova NO, Vorobyeva NM, Tkacheva ON, et al. The prevalence of anemia and its associations with other geriatric syndromes in subjects over 65 years old: data of Russian epidemiological study EVKALIPT. Terapevticheskii Arkhiv (Ter. Arkh.). 2022;94(1):24-31 (in Russian). DOI:10.26442/00403660.2022.01.201316
23. GBD 2021 Anaemia Collaborators. Prevalence, years lived with disability, and trends in anaemia burden by severity and cause, 1990–2021: findings from the Global Burden of Disease Study 2021. Lancet Haematol. 2023;10(9):e713-74. DOI:10.1016/S2352-3026(23)00160-6
24. Sim YE, Abdullah HR. Implications of Anemia in the Elderly Undergoing Surgery. Clin Geriatr Med. 2019;35(3):391-405. DOI:10.1016/j.cger.2019.04.001
25. Valancy D, Blachman-Braun R, Kuchakulla M, et al. Association between low testosterone and anaemia: Analysis of the National Health and Nutrition Examination Survey. Andrologia. 2021;53(11):e14210. DOI:10.1111/and.14210
26. Lanas Á, Carrera-Lasfuentes P, Arguedas Y, et al. Risk of upper and lower gastrointestinal bleeding in patients taking nonsteroidal anti-inflammatory drugs, antiplatelet agents, or anticoagulants. Clin Gastroenterol Hepatol. 2015;13(5):906-12.e2. DOI:10.1016/j.cgh.2014.11.007
27. Stein J, Connor S, Virgin G, et al. Anemia and iron deficiency in gastrointestinal and liver conditions. World J Gastroenterol. 2016;22(35):7908-25. DOI:10.3748/wjg.v22.i35.7908
28. Haile K, Yemane T, Tesfaye G, et al. Anemia and its association with Helicobacter pylori infection among adult dyspeptic patients attending Wachemo University Nigist Eleni Mohammad Memorial Referral Hospital, Southwest Ethiopia: A cross-sectional study. PLoS One. 2021;16(1):e0245168. DOI:10.1371/journal.pone.0245168
29. Ali MD. Proton Pump Inhibitors' Use and Risk of Iron Deficiency Anaemia: A Systematic Review and Meta-analysis. Curr Rev Clin Exp Pharmacol. 2023;18(2):158-66. DOI:10.2174/2772432817666220307121220
30. Anemia and Iron Deficiency in Cancer Patients: Role of Iron Replacement Therapy – Scientific Figure on ResearchGate. Available at: https://www.researchgate.net/figure/Schematic-illustration-of-the-main-mechanisms-contributing-to-an.... Accessed: 20.02.2025.
31. Gilreath JA, Rodgers GM. How I treat cancer-associated anemia. Blood. 2020;136(7):801-13. DOI:10.1182/blood.2019004017
32. Cappellini MD, Comin-Colet J, de Francisco A, et al. Iron deficiency across chronic inflammatory conditions: International expert opinion on definition, diagnosis, and management. Am J Hematol. 2017;92(10):1068-78. DOI:10.1002/ajh.24820
33. Ganz T. Systemic iron homeostasis. Physiol Rev. 2013;93(4):1721-41. DOI:10.1152/physrev.00008.2013
2. Nguyen H, Manolova G, Daskalopoulou C, et al. Prevalence of multimorbidity in community settings: A systematic review and meta-analysis of observational studies. J Comorb. 2019;9:2235042X19870934. DOI:10.1177/2235042X19870934
3. Chowdhury SR, Chandra Das D, Sunna TC, et al. Global and regional prevalence of multimorbidity in the adult population in community settings: a systematic review and meta-analysis. EClinicalMedicine. 2023;57:101860. DOI:10.1016/j.eclinm.2023.101860
4. Zhong Y, Xi H, Guo X, et al. Gender and Socioeconomic Differences in the Prevalence and Patterns of Multimorbidity among Middle-Aged and Older Adults in China. Int J Environ Res Public Health. 2022;19(24). DOI:10.3390/ijerph192416956
5. Stieglitz LM, Bärnighausen T, Leyna GH, et al. Patterns of comorbidity and multimorbidity among middle-aged and elderly women in peri-urban Tanzania. J Multimorb Comorb. 2022;12:26335565221076254. DOI:10.1177/26335565221076254
6. Kuan V, Denaxas S, Patalay P, et al. Identifying and visualising multimorbidity and comorbidity patterns in patients in the English National Health Service: a population-based study. Lancet Digit Health. 2023;5(1):e16-27. DOI:10.1016/S2589-7500(22)00187-X
7. Kohler S, Bärnighausen T, Kazonda P, et al. Chronic Conditions and Multimorbidity Among Middle-Aged and Elderly Peri-Urban Dwellers in Dar es Salaam, Tanzania. Int J Public Health. 2024;69:1606387. DOI:10.3389/ijph.2024.1606387
8. Han S, Li S, Yang Y, et al. Mapping multimorbidity progression among 190 diseases. Commun Med (Lond). 2024;4(1):139. DOI:10.1038/s43856-024-00563-2
9. Haemoglobin concentrations for the diagnosis of anaemia and assessment of severity. World Health Organization, 2011. No. WHO/NMH/NHD/MNM/11.1. Available at: https://www.who.int/publications/i/item/WHO-NMH-NHD-MNM-11.1. Accessed: 20.02.2025.
10. Roso-Llorach A, Vetrano DL, Trevisan C, et al. 12-year evolution of multimorbidity patterns among older adults based on Hidden Markov Models. Aging (Albany NY). 2022;14(24):9805-87. DOI:10.18632/aging.204395
11. Marengoni A, Tazzeo C, Calderón-Larrañaga A, et al. Multimorbidity Patterns and 6-Year Risk of Institutionalization in Older Persons: The Role of Social Formal and Informal Care. J Am Med Dir Assoc. 2021;22(10):2184-9.e1. DOI:10.1016/j.jamda.2020.12.040
12. Akugizibwe R, Calderón-Larrañaga A, Roso-Llorach A, et al. Multimorbidity Patterns and Unplanned Hospitalisation in a Cohort of Older Adults. J Clin Med. 2020;9(12):4001. DOI:10.3390/jcm9124001
13. Воробьева Н.М., Ткачева О.Н., Котовская Ю.В., и др. Российское эпидемиологическое исследование ЭВКАЛИПТ: протокол и базовые характеристики участников. Российский журнал гериатрической медицины. 2021;1(5):35-43 [Vorobyeva NM, Tkacheva ON, Kotovskaya YuV, et al. Russian epidemiological study EVKALIPT: protocol and basic characteristics of participants. Russian Journal of Geriatric Medicine. 2021;1(5):35-43 (in Russian)]. DOI:10.37586/2686-8636-1-2021-35-43
14. Вёрткин А.Л. Коморбидность: история, современное представление, профилактика и лечение. Кардиоваскулярная терапия и профилактика. 2015;14(2):74-9 [Vertkin AL. Comorbidity: history, recent views, prevention and treatment. Cardiovascular Therapy and Prevention. 2015;14(2):74-9 (in Russian)]. DOI:10.15829/1728-8800-2015-2-74-79
15. Garin N, Koyanagi A, Chatterji S, et al. Global Multimorbidity Patterns: A Cross-Sectional, Population-Based, Multi-Country Study. J Gerontol A Biol Sci Med Sci. 2016;71(2):205-14. DOI:10.1093/gerona/glv128
16. Ховасова Н.О., Воробьева Н.М., Наумов А.В., Ткачева О.Н. Влияние анемии на 5-летнюю выживаемость лиц старческого возраста и долгожителей. Лечебное дело. 2022;2:100-9 [Khovasova NO, Vorobieva NM, Naumov AV, Tkacheva ON. Effect of Anemia on 5-Year Survival Rates of Senile People and Centenarians. Lechebnoe delo. 2022;2:100-9 (in Russian)]. DOI:10.24412/2071-5315-2022-12812
17. Girelli D, Marchi G, Camaschella C. Anemia in the Elderly. Hemasphere. 2018;2(3):e40. DOI:10.1097/HS9.0000000000000040
18. Wouters HJCM, van der Klauw MM, de Witte T, et al. Association of anemia with health-related quality of life and survival: a large population-based cohort study. Haematologica. 2019;104(3):468-76. DOI:10.3324/haematol.2018.195552
19. Clancy CC, Browne LD, Gilligan R, et al. Prevalence of anaemia, iron, and vitamin deficiencies in the health system in the Republic of Ireland: a retrospective cohort study. BJGP Open. 2023;8(2):BJGPO.2023.0126. DOI:10.3399/bjgpo.2023.0126
20. Gandhi SJ, Hagans I, Nathan K, et al. Prevalence, Comorbidity and Investigation of Anemia in the Primary Care Office. J Clin Med Res. 2017;9(12):970-80. DOI:10.14740/jocmr3221w
21. Chueh HW, Jung HL, Shim YJ, et al. High anemia prevalence in Korean older adults, an advent healthcare problem: 2007–2016 KNHANES. BMC Geriatr. 2020;20(1):509. DOI:10.1186/s12877-020-01918-9
22. Ховасова Н.О., Воробьева Н.М., Ткачева О.Н., и др. Распространенность анемии и ее ассоциации с другими гериатрическими синдромами у лиц старше 65 лет: данные российского эпидемиологического исследования ЭВКАЛИПТ. Терапевтический архив. 2022;94(1):24-31 [Khovasova NO, Vorobyeva NM, Tkacheva ON, et al. The prevalence of anemia and its associations with other geriatric syndromes in subjects over 65 years old: data of Russian epidemiological study EVKALIPT. Terapevticheskii Arkhiv (Ter. Arkh.). 2022;94(1):24-31 (in Russian)]. DOI:10.26442/00403660.2022.01.201316
23. GBD 2021 Anaemia Collaborators. Prevalence, years lived with disability, and trends in anaemia burden by severity and cause, 1990–2021: findings from the Global Burden of Disease Study 2021. Lancet Haematol. 2023;10(9):e713-74. DOI:10.1016/S2352-3026(23)00160-6
24. Sim YE, Abdullah HR. Implications of Anemia in the Elderly Undergoing Surgery. Clin Geriatr Med. 2019;35(3):391-405. DOI:10.1016/j.cger.2019.04.001
25. Valancy D, Blachman-Braun R, Kuchakulla M, et al. Association between low testosterone and anaemia: Analysis of the National Health and Nutrition Examination Survey. Andrologia. 2021;53(11):e14210. DOI:10.1111/and.14210
26. Lanas Á, Carrera-Lasfuentes P, Arguedas Y, et al. Risk of upper and lower gastrointestinal bleeding in patients taking nonsteroidal anti-inflammatory drugs, antiplatelet agents, or anticoagulants. Clin Gastroenterol Hepatol. 2015;13(5):906-12.e2. DOI:10.1016/j.cgh.2014.11.007
27. Stein J, Connor S, Virgin G, et al. Anemia and iron deficiency in gastrointestinal and liver conditions. World J Gastroenterol. 2016;22(35):7908-25. DOI:10.3748/wjg.v22.i35.7908
28. Haile K, Yemane T, Tesfaye G, et al. Anemia and its association with Helicobacter pylori infection among adult dyspeptic patients attending Wachemo University Nigist Eleni Mohammad Memorial Referral Hospital, Southwest Ethiopia: A cross-sectional study. PLoS One. 2021;16(1):e0245168. DOI:10.1371/journal.pone.0245168
29. Ali MD. Proton Pump Inhibitors' Use and Risk of Iron Deficiency Anaemia: A Systematic Review and Meta-analysis. Curr Rev Clin Exp Pharmacol. 2023;18(2):158-66. DOI:10.2174/2772432817666220307121220
30. Anemia and Iron Deficiency in Cancer Patients: Role of Iron Replacement Therapy – Scientific Figure on ResearchGate. Available at: https://www.researchgate.net/figure/Schematic-illustration-of-the-main-mechanisms-contributing-to-an.... Accessed: 20.02.2025.
31. Gilreath JA, Rodgers GM. How I treat cancer-associated anemia. Blood. 2020;136(7):801-13. DOI:10.1182/blood.2019004017
32. Cappellini MD, Comin-Colet J, de Francisco A, et al. Iron deficiency across chronic inflammatory conditions: International expert opinion on definition, diagnosis, and management. Am J Hematol. 2017;92(10):1068-78. DOI:10.1002/ajh.24820
33. Ganz T. Systemic iron homeostasis. Physiol Rev. 2013;93(4):1721-41. DOI:10.1152/physrev.00008.2013
________________________________________________
2. Nguyen H, Manolova G, Daskalopoulou C, et al. Prevalence of multimorbidity in community settings: A systematic review and meta-analysis of observational studies. J Comorb. 2019;9:2235042X19870934. DOI:10.1177/2235042X19870934
3. Chowdhury SR, Chandra Das D, Sunna TC, et al. Global and regional prevalence of multimorbidity in the adult population in community settings: a systematic review and meta-analysis. EClinicalMedicine. 2023;57:101860. DOI:10.1016/j.eclinm.2023.101860
4. Zhong Y, Xi H, Guo X, et al. Gender and Socioeconomic Differences in the Prevalence and Patterns of Multimorbidity among Middle-Aged and Older Adults in China. Int J Environ Res Public Health. 2022;19(24). DOI:10.3390/ijerph192416956
5. Stieglitz LM, Bärnighausen T, Leyna GH, et al. Patterns of comorbidity and multimorbidity among middle-aged and elderly women in peri-urban Tanzania. J Multimorb Comorb. 2022;12:26335565221076254. DOI:10.1177/26335565221076254
6. Kuan V, Denaxas S, Patalay P, et al. Identifying and visualising multimorbidity and comorbidity patterns in patients in the English National Health Service: a population-based study. Lancet Digit Health. 2023;5(1):e16-27. DOI:10.1016/S2589-7500(22)00187-X
7. Kohler S, Bärnighausen T, Kazonda P, et al. Chronic Conditions and Multimorbidity Among Middle-Aged and Elderly Peri-Urban Dwellers in Dar es Salaam, Tanzania. Int J Public Health. 2024;69:1606387. DOI:10.3389/ijph.2024.1606387
8. Han S, Li S, Yang Y, et al. Mapping multimorbidity progression among 190 diseases. Commun Med (Lond). 2024;4(1):139. DOI:10.1038/s43856-024-00563-2
9. Haemoglobin concentrations for the diagnosis of anaemia and assessment of severity. World Health Organization, 2011. No. WHO/NMH/NHD/MNM/11.1. Available at: https://www.who.int/publications/i/item/WHO-NMH-NHD-MNM-11.1. Accessed: 20.02.2025.
10. Roso-Llorach A, Vetrano DL, Trevisan C, et al. 12-year evolution of multimorbidity patterns among older adults based on Hidden Markov Models. Aging (Albany NY). 2022;14(24):9805-87. DOI:10.18632/aging.204395
11. Marengoni A, Tazzeo C, Calderón-Larrañaga A, et al. Multimorbidity Patterns and 6-Year Risk of Institutionalization in Older Persons: The Role of Social Formal and Informal Care. J Am Med Dir Assoc. 2021;22(10):2184-9.e1. DOI:10.1016/j.jamda.2020.12.040
12. Akugizibwe R, Calderón-Larrañaga A, Roso-Llorach A, et al. Multimorbidity Patterns and Unplanned Hospitalisation in a Cohort of Older Adults. J Clin Med. 2020;9(12):4001. DOI:10.3390/jcm9124001
13. Vorobyeva NM, Tkacheva ON, Kotovskaya YuV, et al. Russian epidemiological study EVKALIPT: protocol and basic characteristics of participants. Russian Journal of Geriatric Medicine. 2021;1(5):35-43 (in Russian). DOI:10.37586/2686-8636-1-2021-35-43
14. Vertkin AL. Comorbidity: history, recent views, prevention and treatment. Cardiovascular Therapy and Prevention. 2015;14(2):74-9 (in Russian). DOI:10.15829/1728-8800-2015-2-74-79
15. Garin N, Koyanagi A, Chatterji S, et al. Global Multimorbidity Patterns: A Cross-Sectional, Population-Based, Multi-Country Study. J Gerontol A Biol Sci Med Sci. 2016;71(2):205-14. DOI:10.1093/gerona/glv128
16. Khovasova NO, Vorobieva NM, Naumov AV, Tkacheva ON. Effect of Anemia on 5-Year Survival Rates of Senile People and Centenarians. Lechebnoe delo. 2022;2:100-9 (in Russian). DOI:10.24412/2071-5315-2022-12812
17. Girelli D, Marchi G, Camaschella C. Anemia in the Elderly. Hemasphere. 2018;2(3):e40. DOI:10.1097/HS9.0000000000000040
18. Wouters HJCM, van der Klauw MM, de Witte T, et al. Association of anemia with health-related quality of life and survival: a large population-based cohort study. Haematologica. 2019;104(3):468-76. DOI:10.3324/haematol.2018.195552
19. Clancy CC, Browne LD, Gilligan R, et al. Prevalence of anaemia, iron, and vitamin deficiencies in the health system in the Republic of Ireland: a retrospective cohort study. BJGP Open. 2023;8(2):BJGPO.2023.0126. DOI:10.3399/bjgpo.2023.0126
20. Gandhi SJ, Hagans I, Nathan K, et al. Prevalence, Comorbidity and Investigation of Anemia in the Primary Care Office. J Clin Med Res. 2017;9(12):970-80. DOI:10.14740/jocmr3221w
21. Chueh HW, Jung HL, Shim YJ, et al. High anemia prevalence in Korean older adults, an advent healthcare problem: 2007–2016 KNHANES. BMC Geriatr. 2020;20(1):509. DOI:10.1186/s12877-020-01918-9
22. Khovasova NO, Vorobyeva NM, Tkacheva ON, et al. The prevalence of anemia and its associations with other geriatric syndromes in subjects over 65 years old: data of Russian epidemiological study EVKALIPT. Terapevticheskii Arkhiv (Ter. Arkh.). 2022;94(1):24-31 (in Russian). DOI:10.26442/00403660.2022.01.201316
23. GBD 2021 Anaemia Collaborators. Prevalence, years lived with disability, and trends in anaemia burden by severity and cause, 1990–2021: findings from the Global Burden of Disease Study 2021. Lancet Haematol. 2023;10(9):e713-74. DOI:10.1016/S2352-3026(23)00160-6
24. Sim YE, Abdullah HR. Implications of Anemia in the Elderly Undergoing Surgery. Clin Geriatr Med. 2019;35(3):391-405. DOI:10.1016/j.cger.2019.04.001
25. Valancy D, Blachman-Braun R, Kuchakulla M, et al. Association between low testosterone and anaemia: Analysis of the National Health and Nutrition Examination Survey. Andrologia. 2021;53(11):e14210. DOI:10.1111/and.14210
26. Lanas Á, Carrera-Lasfuentes P, Arguedas Y, et al. Risk of upper and lower gastrointestinal bleeding in patients taking nonsteroidal anti-inflammatory drugs, antiplatelet agents, or anticoagulants. Clin Gastroenterol Hepatol. 2015;13(5):906-12.e2. DOI:10.1016/j.cgh.2014.11.007
27. Stein J, Connor S, Virgin G, et al. Anemia and iron deficiency in gastrointestinal and liver conditions. World J Gastroenterol. 2016;22(35):7908-25. DOI:10.3748/wjg.v22.i35.7908
28. Haile K, Yemane T, Tesfaye G, et al. Anemia and its association with Helicobacter pylori infection among adult dyspeptic patients attending Wachemo University Nigist Eleni Mohammad Memorial Referral Hospital, Southwest Ethiopia: A cross-sectional study. PLoS One. 2021;16(1):e0245168. DOI:10.1371/journal.pone.0245168
29. Ali MD. Proton Pump Inhibitors' Use and Risk of Iron Deficiency Anaemia: A Systematic Review and Meta-analysis. Curr Rev Clin Exp Pharmacol. 2023;18(2):158-66. DOI:10.2174/2772432817666220307121220
30. Anemia and Iron Deficiency in Cancer Patients: Role of Iron Replacement Therapy – Scientific Figure on ResearchGate. Available at: https://www.researchgate.net/figure/Schematic-illustration-of-the-main-mechanisms-contributing-to-an.... Accessed: 20.02.2025.
31. Gilreath JA, Rodgers GM. How I treat cancer-associated anemia. Blood. 2020;136(7):801-13. DOI:10.1182/blood.2019004017
32. Cappellini MD, Comin-Colet J, de Francisco A, et al. Iron deficiency across chronic inflammatory conditions: International expert opinion on definition, diagnosis, and management. Am J Hematol. 2017;92(10):1068-78. DOI:10.1002/ajh.24820
33. Ganz T. Systemic iron homeostasis. Physiol Rev. 2013;93(4):1721-41. DOI:10.1152/physrev.00008.2013
Авторы
Н.О. Ховасова*, Н.М. Воробьёва, А.В. Наумов, И.П. Малая, Ю.В. Котовская, О.Н. Ткачёва
ФГАОУ ВО «Российский национальный исследовательский медицинский университет им. Н.И. Пирогова» Минздрава России (Пироговский Университет), Москва, Россия
*natashahov@mail.ru
Pirogov Russian National Research Medical University (Pirogov University), Moscow, Russia
*natashahov@mail.ru
ФГАОУ ВО «Российский национальный исследовательский медицинский университет им. Н.И. Пирогова» Минздрава России (Пироговский Университет), Москва, Россия
*natashahov@mail.ru
________________________________________________
Pirogov Russian National Research Medical University (Pirogov University), Moscow, Russia
*natashahov@mail.ru
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