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Serum albumin and mortality in the BUPA study. British United Provident Association
M R Law1, J K Morris, N J Wald
1Department of Environmental and Preventive Medicine, Medical College of St Bartholomew's Hospital, London, UK.
Insights
This study found no direct link between low serum albumin and overall mortality in men. While some diseases may lower albumin, it does not appear to be a direct cause of death.
Area of Science:
- Biochemistry
- Epidemiology
- Gerontology
Background:
- Low serum albumin is often associated with increased mortality in observational studies.
- The causal relationship between serum albumin levels and mortality requires further investigation.
Purpose of the Study:
- To investigate the association between serum albumin levels and all-cause mortality in a large cohort of men.
- To explore cause-specific mortality associations with serum albumin.
Main Methods:
- Prospective observational study of 21,520 men.
- Serum albumin levels of 877 deceased men were compared to 877 matched controls.
- Analysis included cause-specific mortality data.
Main Results:
- No significant overall difference in serum albumin between cases and controls.
- Low albumin was not associated with ischemic heart disease or other circulatory diseases.
- Associations with cancer were limited to early follow-up, likely due to pre-clinical disease; associations with chronic diseases (respiratory, renal, liver, gut, neurological) were observed, consistent with pre-clinical disease effects.
Conclusions:
- The study does not support a direct cause-and-effect relationship between low serum albumin and mortality.
- Low serum albumin may be a marker of underlying chronic disease rather than a direct cause of death.
Abstract:
In the British United Provident Association (BUPA) study, a prospective observational study of 21,520 men, the serum albumin of 877 men who died during 10 years of follow-up was compared with that of 877 controls, each matched to a case by age (within 1 year) and date of attendance (within 3 months). There was little overall difference (mean case-control difference = -0.11 milligram, P > 0.2) despite the fact that other studies have reported a long-term association between low serum albumin and increased mortality. Cause-specific mortality data showed no association of low albumin with ischaemic heart disease or other circulatory diseases. An inverse association with cancer was confined to the first few years of follow-up and so attributable to pre-clinical cancer lowering both serum albumin itself and serum cholesterol, with which albumin was associated. There was an association of chronic respiratory, neurological, renal, liver and gut diseases with low serum albumin (case-control difference = -1.19 milligram, P < 0.001) consistent with the effect of pre-clinical disease lowering serum albumin. Other causes of death showed no association with albumin. Our data do not support a cause and effect association of low serum albumin and mortality.