Older Male Patients Report Higher Rates of Diabetes, Depression, Anxiety

Lower incidence of heart attack and coronary heart disease reported in same study

Marisa Wexler, MS avatar

by Marisa Wexler, MS |

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Older men with hemophilia report higher rates of anxiety, depression, and diabetes compared with the general U.S. population, a recent study reported.

However, rates of heart-related health problems, such as myocardial infarction (heart attack) and coronary heart disease, were lower in hemophilia patients than in the general population.

The study, “Prevalence of comorbid conditions among older males with haemophilia receiving care in haemophilia treatment centers in the United States,” was published in the journal Haemophilia.

With new advances in care, people with hemophilia are living longer, healthier lives than ever before. As more and more people with hemophilia reach older age, it is expected that there will be more hemophilia patients with age-related comorbidities (co-occurring health conditions).

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To learn more about comorbidities common in older hemophilia patients, a quartet of scientists conducted an analysis of data collected across more than 100 hemophilia treatment centers in the U.S.

The data were collected through a public health surveillance system called Community Counts, launched via a partnership between the Centers for Disease Control and Prevention (CDC), the American Thrombosis and Hemostasis Network (ATHN), and the U.S. Hemophilia Treatment Center Network (USHTCN).

In total, the analysis included data from 2,237 hemophilia patients, ages 45 and older, who were seen at hemophilia treatment centers from 2013 through 2021. About three-quarters had hemophilia A, while the rest had hemophilia B. About three in four had a history of hepatitis C infection, while just over 24% had a history of human immunodeficiency virus (HIV) infection. All of the patients were male, and 86.5% were white and non-Hispanic.

Rates of comorbidities in these patients were compared against rates seen in the general U.S. male population, based on data collected through the CDC’s National Health Interview Survey (NHIS) in 2018 and 2019.

Overall, common comorbidities reported in hemophilia patients “mirror those in the general population,” the researchers wrote. Nonetheless, “rates differ somewhat between the populations.”

Diabetes, depression, anxiety

Compared with the general population of U.S. males, a significantly higher proportion of men with hemophilia had diabetes (24% vs. 15.8%), anxiety (18.5% vs. 9%), or depression (21.9% vs. 11.2%).

These trends were generally consistent in further analyses that divided patients by age into “middle-aged” (45–64 years) and “elderly” (ages 65 and older). In particular, rates of anxiety and depression were much higher in hemophilia patients, researchers noted.

“Males with haemophilia had a much higher prevalence of anxiety and depression in both age groups compared to the general population. The prevalence of these conditions was more than double among middle-aged and about one-third higher among older males with haemophilia,” they wrote.

The team added that the high rate of mental health problems “highlights the underlying psychological burdens” that come with living with hemophilia, and they called for further work to provide support to patients struggling with these issues.

Reasons for the higher incidence of diabetes among hemophilia patients are still unclear, though it may be potentially linked to a higher incidence of hepatitis C infection or obesity. Researchers said they are not aware of any prior research linking hemophilia and diabetes.

“Additional investigation is needed to understand why the haemophilia population has a higher rate of these comorbidities and how they affect overall health and wellbeing,” they wrote.

Hemophilia patients had lower rates of heart-related problems compared with the general U.S. male population. These included high blood pressure (38.6% vs. 49.5%), coronary artery disease (6.4% vs. 13.8%), stroke (2.4% vs. 5.3%), and myocardial infarction (2.2% vs. 7.6%).

Scientists speculated that hemophilia patients may be at a lower risk of developing these issues that often involve disease-associated blood clots, since by definition people with hemophilia have blood clotting issues. The team noted that, if this is the case, heart problems in hemophilia patients will likely become more common as treatment strategies to promote normal blood clotting continue to improve.

“Further study is needed to understand the impact of haemophilia on cardiovascular outcomes especially given the unique challenges of managing cardiovascular disease in the haemophilia population,” they wrote.