TY - JOUR
T1 - Serum albumin and risks of hospitalization and death
T2 - Findings from the Atherosclerosis Risk in Communities study
AU - Shannon, Colleen M.
AU - Ballew, Shoshana H.
AU - Daya, Natalie
AU - Zhou, Linda
AU - Chang, Alex R.
AU - Sang, Yingying
AU - Coresh, Josef
AU - Selvin, Elizabeth
AU - Grams, Morgan E.
N1 - Funding Information:
The Atherosclerosis Risk in Communities study has been funded in whole or in part with federal funds from the National Heart, Lung, and Blood Institute; National Institutes of Health; and Department of Health and Human Services under the following contract numbers: HHSN268201700001I, HHSN268201700002I, HHSN268201700003I, HHSN268201700005I, and HHSN268201700004I. The authors thank the staff and participants of the ARIC study for their important contributions. This submission was made possible by the Johns Hopkins Institute for Clinical and Translational Research (ICTR), which is funded in part by grant TL1 TR001078 from the National Institute of Health (NIH) National Center for Advancing Translational Sciences (NCATS) and NIH Roadmap for Medical Research. Its contents are solely the responsibility of the authors and do not necessarily represent the official view of the Johns Hopkins ICTR, NCATS, or NIH. Reagents for the albumin assays were donated by Asahi Kasei Corporation. This work was supported by NIH/National Institute of Diabetes and Digestive and Kidney Disease (NIDDK) Grant R01DK089174 to Elizabeth Selvin. Elizabeth Selvin was also supported by K24DK106414. Morgan E. Grams was supported by K24HL155861.
Funding Information:
The Atherosclerosis Risk in Communities study has been funded in whole or in part with federal funds from the National Heart, Lung, and Blood Institute; National Institutes of Health; and Department of Health and Human Services under the following contract numbers: HHSN268201700001I, HHSN268201700002I, HHSN268201700003I, HHSN268201700005I, and HHSN268201700004I. The authors thank the staff and participants of the ARIC study for their important contributions. This submission was made possible by the Johns Hopkins Institute for Clinical and Translational Research (ICTR), which is funded in part by grant TL1 TR001078 from the National Institute of Health (NIH) National Center for Advancing Translational Sciences (NCATS) and NIH Roadmap for Medical Research. Its contents are solely the responsibility of the authors and do not necessarily represent the official view of the Johns Hopkins ICTR, NCATS, or NIH. Reagents for the albumin assays were donated by Asahi Kasei Corporation. This work was supported by NIH/National Institute of Diabetes and Digestive and Kidney Disease (NIDDK) Grant R01DK089174 to Elizabeth Selvin. Elizabeth Selvin was also supported by K24DK106414. Morgan E. Grams was supported by K24HL155861.
Funding Information:
Asahi Kasei Pharma Corporation; National Center for Advancing Translational Sciences, Grant/Award Number: TL1 TR001078; National Heart, Lung, and Blood Institute, Grant/Award Numbers: HHSN268201700001I, HHSN268201700002I, HHSN268201700003I, HHSN268201700004I, HHSN268201700005I; National Institute of Diabetes and Digestive and Kidney Diseases, Grant/Award Number: R01DK089174; NIH Roadmap for Medical Research; National Institutes of Health Funding information
Publisher Copyright:
© 2021 The Authors. Journal of the American Geriatrics Society published by Wiley Periodicals LLC on behalf of The American Geriatrics Society.
PY - 2021/10
Y1 - 2021/10
N2 - Objectives: To determine whether lower serum albumin in community-dwelling, older adults is associated with increased risk of hospitalization and death independent of pre-existing disease. Design: Prospective cohort study of participants in the fifth visit of the Atherosclerosis Risk in Communities (ARIC) study. Baseline data were collected from 2011 to 2013. Follow-up was available to December 31, 2017. Replication was performed in Geisinger, a health system in rural Pennsylvania. Setting: For ARIC, four US communities: Washington County, Maryland; Forsyth County, North Carolina; Jackson, Mississippi; and suburbs of Minneapolis, Minnesota. Participants: A total of 4947 community-dwelling men and women aged 66 to 90 years. Exposure: Serum albumin. Main Outcomes: Incident all-cause hospitalization and death. Results: Among the 4947 participants, mean age was 75.5 years (SD: 5.12) and mean baseline serum albumin concentration was 4.05 g/dL (SD: 0.30). Over a median follow-up period of 4.42 years (interquartile interval: 4.16–5.05), 553 participants (11.2%) died and 2457 participants (49.7%) were hospitalized at least once. The total number of hospitalizations was 5725. In analyses adjusted for demographics and numerous clinical characteristics, including tobacco use, obesity, frailty, cardiovascular disease, kidney disease, diabetes C-reactive protein (CRP), cognitive status, alcohol use, medication use, respiratory disease, and systolic blood pressure, 1 g/dL lower baseline serum albumin concentration was associated with higher risk of both hospitalization (incidence rate ratio [IRR]: 1.58; 95% confidence interval [CI]: 1.36–1.82; p < 0.001) and death (hazard ratio [HR]: 1.67; 95% CI: 1.24–2.24; p < 0.001). Associations were weaker with older age but not different by frailty status or level of high-sensitivity CRP. Associations between serum albumin, hospitalizations, and death were also similar in a real-world cohort of primary care patients. Conclusions: Lower baseline serum albumin was significantly associated with increased risk of both all-cause hospitalization and death, independent of pre-existing disease. Older adults with low serum albumin should be considered a high-risk population and targeted for interventions to reduce the risk of adverse outcomes.
AB - Objectives: To determine whether lower serum albumin in community-dwelling, older adults is associated with increased risk of hospitalization and death independent of pre-existing disease. Design: Prospective cohort study of participants in the fifth visit of the Atherosclerosis Risk in Communities (ARIC) study. Baseline data were collected from 2011 to 2013. Follow-up was available to December 31, 2017. Replication was performed in Geisinger, a health system in rural Pennsylvania. Setting: For ARIC, four US communities: Washington County, Maryland; Forsyth County, North Carolina; Jackson, Mississippi; and suburbs of Minneapolis, Minnesota. Participants: A total of 4947 community-dwelling men and women aged 66 to 90 years. Exposure: Serum albumin. Main Outcomes: Incident all-cause hospitalization and death. Results: Among the 4947 participants, mean age was 75.5 years (SD: 5.12) and mean baseline serum albumin concentration was 4.05 g/dL (SD: 0.30). Over a median follow-up period of 4.42 years (interquartile interval: 4.16–5.05), 553 participants (11.2%) died and 2457 participants (49.7%) were hospitalized at least once. The total number of hospitalizations was 5725. In analyses adjusted for demographics and numerous clinical characteristics, including tobacco use, obesity, frailty, cardiovascular disease, kidney disease, diabetes C-reactive protein (CRP), cognitive status, alcohol use, medication use, respiratory disease, and systolic blood pressure, 1 g/dL lower baseline serum albumin concentration was associated with higher risk of both hospitalization (incidence rate ratio [IRR]: 1.58; 95% confidence interval [CI]: 1.36–1.82; p < 0.001) and death (hazard ratio [HR]: 1.67; 95% CI: 1.24–2.24; p < 0.001). Associations were weaker with older age but not different by frailty status or level of high-sensitivity CRP. Associations between serum albumin, hospitalizations, and death were also similar in a real-world cohort of primary care patients. Conclusions: Lower baseline serum albumin was significantly associated with increased risk of both all-cause hospitalization and death, independent of pre-existing disease. Older adults with low serum albumin should be considered a high-risk population and targeted for interventions to reduce the risk of adverse outcomes.
KW - bromocresol purple
KW - death
KW - frailty
KW - hospitalization
KW - serum albumin
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U2 - 10.1111/jgs.17313
DO - 10.1111/jgs.17313
M3 - Article
C2 - 34298583
AN - SCOPUS:85111340887
SN - 0002-8614
VL - 69
SP - 2865
EP - 2876
JO - Journal of the American Geriatrics Society
JF - Journal of the American Geriatrics Society
IS - 10
ER -