Anemia is an independent predictor of increased overall mortality in older adults – results from the PolSenior study

Background Although anemia in old age is traditionally viewed as a benign bystander of the aging process, its systemic impact on population health remains underestimated. This study evaluates the long-term health consequences of established hemoglobin concentration cut-off values by analyzing their independent impact on 10-year mortality and functional independence among community-dwelling older adults. Participants and methods 3,806 people aged 65 to 103 (1811 women, 1995 men) participated in the PolSenior project, a nationwide cross-sectional study with a 10-year prospective follow-up for mortality. We used ROC curve analysis to determine sex-specific hemoglobin cut-offs for mortality risk. Comprehensive geriatric assessments, including activities of daily living (ADLs/IADLs), cognitive status, nutritional risk, and inflammatory markers (IL-6, CRP), were analyzed across hemoglobin ranges using multivariable stepwise Cox proportional hazard regression stratified by age and renal function. Results During the 10-year follow-up period, 56.9% of the participants died. We established empirical hemoglobin cut-off values above which mortality increases sharply: 13.3 g/dL for women and 13.9 g/dL for men. Subgroups with results below these thresholds exhibited significantly higher mortality ( p < 0.001) and a higher incidence of dementia, depression, malnutrition, falls, and severe impairment in ADL/IADL. Multivariate analysis confirmed that the increased risk of death associated with low hemoglobin levels persisted independently of the presence of major chronic diseases and systemic inflammation. Conclusion This study provides the first nationwide evidence of distinct, sex-specific hemoglobin thresholds that independently influence long-term mortality and declines in functional ability. These findings highlight a key public health challenge: even a slight decrease in hemoglobin concentration represents a significant, modifiable risk factor for the loss of independence among the older adults. Public health strategies for healthy aging should incorporate proactive, community-based screening for anemia to delay the onset of disability and reduce the socioeconomic burden on aging healthcare systems.