Serum albumin level and physical disability as predictors of mortality in older persons

Objectives. —To study the relationship between serum albumin level and all-cause mortality in an elderly population and to evaluate the role of albumin level in combination with physical disability status in predicting mortality. Design. —Cohort study with a mean follow-up of 3.7 years. Setting. —Three communities: East Boston, Mass, New Haven, Conn, and Iowa and Washington counties, Iowa. Subjects. —A total of 1486 men and 2630 women aged 71 years and older who consented to have blood drawn. Results. —During follow-up, 447 men and 488 women died. In both sexes, there was a graded increase in mortality rate with decreasing albumin level. After adjusting for age, race, education, chronic conditions, and disability status, hypoalbuminemia (Conclusions. —Serum albumin level is an independent risk factor for all-cause mortality in older persons. A combined measure of albumin and disability reveals a strong gradient in mortality risk and may serve as a simple but useful index of frailty that can identify a high-risk group of older men and women who could be targeted for preventive and treatment efforts. (JAMA. 1994;272:1036-1042)