Study Finds Men with Hemophilia Have Higher Rates of Depression, Anxiety, and Obesity than the General U.S. Male Population

Hemophilia is a rare, inherited bleeding disorder in which the blood does not clot properly. Blood contains many proteins called clotting factors that can help stop bleeding. People with hemophilia have low levels of either factor VIII (8) or factor IX (9) blood clotting proteins. Hemophilia A is caused by low levels of factor VIII, and hemophilia B is caused by low levels of factor IX. Hemophilia can lead to excessive bleeding after an injury or trauma, as well as bleeding that can occur for no apparent reason.

Medical advancements have helped people with hemophilia live longer, but longer life can lead to other health problems that can develop with age, such as high blood pressure and obesity. These health problems can have serious consequences on one’s overall health and well-being, and they can be challenging to treat in a person with a bleeding disorder. As more people with hemophilia are living longer, it’s important to know what other health problems are affecting the aging hemophilia community to better understand the healthcare needs of this population.

About the Study

Community Counts is a public health tracking system that monitors the care and health outcomes of patients with bleeding disorders receiving care at federally funded hemophilia treatment centers (HTCs) across the United States.

Prevalence is a statistical concept referring to the number of people (existing cases) who have a disease or medical condition at a particular time.

Researchers from the Centers for Disease Control and Prevention (CDC) and the U.S. HTC Network analyzed information from Community Counts on men age 45 years and older who were receiving care for hemophilia at HTCs from December 2013 to March 2021. The study aimed to

• Examine the different conditions affecting the health of men with hemophilia, and
• Compare the prevalence of these conditions in this population with that in similar-aged men in the general U.S. population

Since the study examined age-related health conditions, researchers divided the men with hemophilia into two groups—middle-aged (age 45 to 64 years) and older (age 65 years or more)—for comparison.

To compare the group with hemophilia with the general U.S. population, researchers used similar information collected in the CDC’s National Health Interview Survey.

Read the full scientific article.

Main Findings

Overview of the Study Sample

• The study included 2,237 males age 45 and older with hemophilia A and B.
  • About 3 in 4 men had hemophilia A. About 1 in 4 had hemophilia B.
  • Among men with hemophilia A, about 40% had severe hemophilia, 20% had moderate hemophilia, and 40% had mild hemophilia.
  • Among men with hemophilia B, about 30% had severe hemophilia, 40% had moderate hemophilia, and 30% had mild hemophilia.
  • The majority of men were non-Hispanic and white.
  • About 71% of men in this study were 45 to 64 years of age, and 29% were age 65 and older.
  • Men in the younger age group were more likely to have severe hemophilia than men in the older age group.
• Nearly 3 in 4 men with hemophilia had a history of prior hepatitis C virus (HCV) infection, and about 1 in 4 had a history of human immunodeficiency virus (HIV) infection.
  • Men with a history of HIV or HCV infection had a higher prevalence of chronic kidney disease, liver cancer, anxiety, and depression than those without infections.

Comparison with the General U.S. Male Population

• In both age groups men with hemophilia had
  • Lower prevalence of coronary artery disease, stroke, heart attack, and leukemia, and
  • Higher prevalence of anxiety, depression, and obesity.
• Men with hemophilia in the older group had a lower prevalence of all cancers and a higher prevalence of obesity compared with same-age men in the general U.S. male population.
• Men with hemophilia in the younger group had a lower prevalence of leukemia and higher prevalence of chronic kidney disease compared with same-age men in the general U.S. male population.

Differences in Health Conditions by Severity Level

• Compared with men with mild or moderate hemophilia, men with severe hemophilia had
  • Higher prevalence of diabetes, liver cancer, anxiety, depression, and obesity, and
  • Lower prevalence of heart disease.
• Prevalence of high blood pressure increased with hemophilia severity.

Gaps and Future Directions

Gaps

• The study found that men with hemophilia had lower rates of heart disease compared with the general U.S. male population. Additionally, the prevalence of heart disease was lower among men with severe hemophilia compared with those with mild hemophilia. These findings suggest that hemophilia may protect against, or make it less likely to develop, heart disease. However, previous studies are inconsistent, and more research is needed to understand the relationship between heart disease and hemophilia.
• Although men with hemophilia had a lower prevalence of high blood pressure than the general U.S. population, the prevalence of high blood pressure increased with hemophilia severity. The reasons for this are not known.

Future Directions

As people living with hemophilia are now living longer, it’s important to understand why they experience higher rates of certain health problems, such as depression, anxiety, and obesity. Understanding how these health problems impact overall health and well-being will allow researchers to better address the healthcare needs of the aging hemophilia community.

Paper Reference

Soucie JM, Le B, Dupervil B, Poston JN. Prevalence of comorbid conditions among older males with haemophilia receiving care in haemophilia treatment centers in the United States. Haemophilia. 2022;28:986–995.
https://doi.org/10.1111/hae.14647.

Source: Centers for Disease Control and Prevention, July 2023