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Published in: Journal of Hematology & Oncology 1/2021

Open Access 01-12-2021 | Anemia | Research

Burden of anemia and its underlying causes in 204 countries and territories, 1990–2019: results from the Global Burden of Disease Study 2019

Authors: Saeid Safiri, Ali-Asghar Kolahi, Maryam Noori, Seyed Aria Nejadghaderi, Nahid Karamzad, Nicola Luigi Bragazzi, Mark J. M. Sullman, Morteza Abdollahi, Gary S. Collins, Jay S. Kaufman, Jessica A. Grieger

Published in: Journal of Hematology & Oncology | Issue 1/2021

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Abstract

Background

Anemia is a common disease which affects around 40% of children and 30% of reproductive age women and can have major health consequences. The present study reports the global, regional and national burden of anemia and its underlying causes between 1990 and 2019, by age, sex and socio-demographic index (SDI).

Methods

Publicly available data on the point prevalence and years lived with disability (YLDs) were retrieved from the global burden of disease (GBD) 2019 study for 204 countries and territories between 1990 and 2019. The point prevalence, YLD counts and rates per 100,000 population were presented, along with their corresponding 95% uncertainty intervals.

Results

In 2019, the global age-standardized point prevalence and YLD rates for anemia were 23,176.2 (22,943.5–23,418.6) and 672.4 (447.2–981.5) per 100,000 population, respectively. Moreover, the global age-standardized point prevalence and YLD rate decreased by 13.4% (12.1–14.5%) and 18.8% (16.9–20.8%), respectively, over the period 1990–2019. The highest national point prevalences of anemia were found in Zambia [49327.1 (95% UI: 46,838.5–51,700.1)], Mali [46890.1 (95% UI: 44,301.1–49,389.8)], and Burkina Faso [46117.2 (95% UI: 43,640.7–48,319.2)]. In 2019, the global point prevalence of anemia was highest in the 15–19 and 95+ age groups in females and males, respectively. Also, the burden of anemia was lower in regions with higher socio-economic development. Globally, most of the prevalent cases were attributable to dietary iron deficiency, as well as hemoglobinopathies and hemolytic anemias.

Conclusions

Anemia remains a major health problem, especially among females in less developed countries. The implementation of preventive programs with a focus on improving access to iron supplements, early diagnosis and the treatment of hemoglobinopathies should be taken into consideration.
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Literature
1.
go back to reference Domenica Cappellini M, Motta I. Anemia in clinical practice—definition and classification: Does hemoglobin change with aging? Semin Hematol. 2015;52(4):261–9.PubMedCrossRef Domenica Cappellini M, Motta I. Anemia in clinical practice—definition and classification: Does hemoglobin change with aging? Semin Hematol. 2015;52(4):261–9.PubMedCrossRef
2.
go back to reference Cardoso MA, Scopel KKG, Muniz PT, Villamor E, Ferreira MU. Underlying factors associated with anemia in amazonian children: a population-based, cross-sectional study. PLoS ONE. 2012;7(5):e36341.PubMedPubMedCentralCrossRef Cardoso MA, Scopel KKG, Muniz PT, Villamor E, Ferreira MU. Underlying factors associated with anemia in amazonian children: a population-based, cross-sectional study. PLoS ONE. 2012;7(5):e36341.PubMedPubMedCentralCrossRef
3.
go back to reference Beghé C, Wilson A, Ershler WB. Prevalence and outcomes of anemia in geriatrics: a systematic review of the literature. Am J Med. 2004;116(7, Supplement 1):3–10.CrossRef Beghé C, Wilson A, Ershler WB. Prevalence and outcomes of anemia in geriatrics: a systematic review of the literature. Am J Med. 2004;116(7, Supplement 1):3–10.CrossRef
5.
6.
go back to reference Groenveld Hessel F, Januzzi James L, Damman K, van Wijngaarden J, Hillege Hans L, van Veldhuisen Dirk J, et al. Anemia and mortality in heart failure patients. J Am Coll Cardiol. 2008;52(10):818–27.PubMedCrossRef Groenveld Hessel F, Januzzi James L, Damman K, van Wijngaarden J, Hillege Hans L, van Veldhuisen Dirk J, et al. Anemia and mortality in heart failure patients. J Am Coll Cardiol. 2008;52(10):818–27.PubMedCrossRef
7.
go back to reference Ershler WB, Chen K, Reyes EB, Dubois R. Economic burden of patients with anemia in selected diseases. Value Health J Int Soc Pharmacoecon Outcomes Res. 2005;8(6):629–38.CrossRef Ershler WB, Chen K, Reyes EB, Dubois R. Economic burden of patients with anemia in selected diseases. Value Health J Int Soc Pharmacoecon Outcomes Res. 2005;8(6):629–38.CrossRef
8.
go back to reference Kassebaum NJ, Jasrasaria R, Naghavi M, Wulf SK, Johns N, Lozano R, et al. A systematic analysis of global anemia burden from 1990 to 2010. Blood. 2014;123(5):615–24.PubMedPubMedCentralCrossRef Kassebaum NJ, Jasrasaria R, Naghavi M, Wulf SK, Johns N, Lozano R, et al. A systematic analysis of global anemia burden from 1990 to 2010. Blood. 2014;123(5):615–24.PubMedPubMedCentralCrossRef
9.
go back to reference Stevens GA, Finucane MM, De-Regil LM, Paciorek CJ, Flaxman SR, Branca F, et al. Global, regional, and national trends in haemoglobin concentration and prevalence of total and severe anaemia in children and pregnant and non-pregnant women for 1995–2011: a systematic analysis of population-representative data. Lancet Glob Health. 2013;1(1):e16-25.PubMedPubMedCentralCrossRef Stevens GA, Finucane MM, De-Regil LM, Paciorek CJ, Flaxman SR, Branca F, et al. Global, regional, and national trends in haemoglobin concentration and prevalence of total and severe anaemia in children and pregnant and non-pregnant women for 1995–2011: a systematic analysis of population-representative data. Lancet Glob Health. 2013;1(1):e16-25.PubMedPubMedCentralCrossRef
10.
go back to reference Kassebaum NJ, Collaborators GA. The global burden of anemia. Hematol Oncol Clin N Am. 2016;30(2):247–308.CrossRef Kassebaum NJ, Collaborators GA. The global burden of anemia. Hematol Oncol Clin N Am. 2016;30(2):247–308.CrossRef
11.
go back to reference Gardner W, Kassebaum N. Global, regional, and national prevalence of anemia and its causes in 204 countries and territories, 1990–2019. Curr Dev Nutr. 2020;4(Supplement_2):830.PubMedCentralCrossRef Gardner W, Kassebaum N. Global, regional, and national prevalence of anemia and its causes in 204 countries and territories, 1990–2019. Curr Dev Nutr. 2020;4(Supplement_2):830.PubMedCentralCrossRef
12.
go back to reference Vos T, Lim SS, Abbafati C, Abbas KM, Abbasi M, Abbasifard M, et al. Global burden of 369 diseases and injuries in 204 countries and territories, 1990–2019: a systematic analysis for the global burden of disease study 2019. Lancet. 2020;396(10258):1204–22.CrossRef Vos T, Lim SS, Abbafati C, Abbas KM, Abbasi M, Abbasifard M, et al. Global burden of 369 diseases and injuries in 204 countries and territories, 1990–2019: a systematic analysis for the global burden of disease study 2019. Lancet. 2020;396(10258):1204–22.CrossRef
13.
go back to reference Murray CJL, Aravkin AY, Zheng P, Abbafati C, Abbas KM, Abbasi-Kangevari M, et al. Global burden of 87 risk factors in 204 countries and territories, 1990–2019: a systematic analysis for the global burden of disease study 2019. Lancet. 2020;396(10258):1223–49.CrossRef Murray CJL, Aravkin AY, Zheng P, Abbafati C, Abbas KM, Abbasi-Kangevari M, et al. Global burden of 87 risk factors in 204 countries and territories, 1990–2019: a systematic analysis for the global burden of disease study 2019. Lancet. 2020;396(10258):1223–49.CrossRef
14.
go back to reference World Health Organization. Haemoglobin concentrations for the diagnosis of anaemia and assessment of severity. Geneva: World Health Organization; 2011. World Health Organization. Haemoglobin concentrations for the diagnosis of anaemia and assessment of severity. Geneva: World Health Organization; 2011.
15.
go back to reference Salomon JA, Haagsma JA, Davis A, de Noordhout CM, Polinder S, Havelaar AH, et al. Disability weights for the global burden of disease 2013 study. Lancet Glob Health. 2015;3(11):e712–23.PubMedCrossRef Salomon JA, Haagsma JA, Davis A, de Noordhout CM, Polinder S, Havelaar AH, et al. Disability weights for the global burden of disease 2013 study. Lancet Glob Health. 2015;3(11):e712–23.PubMedCrossRef
16.
go back to reference Wang Y. Smoothing splines: methods and applications. London: Chapman and Hall/CRC; 2011.CrossRef Wang Y. Smoothing splines: methods and applications. London: Chapman and Hall/CRC; 2011.CrossRef
17.
go back to reference McLean E, Cogswell M, Egli I, Wojdyla D, de Benoist B. Worldwide prevalence of anaemia, WHO vitamin and mineral nutrition information system, 1993–2005. Public Health Nutr. 2009;12(4):444–54.PubMedCrossRef McLean E, Cogswell M, Egli I, Wojdyla D, de Benoist B. Worldwide prevalence of anaemia, WHO vitamin and mineral nutrition information system, 1993–2005. Public Health Nutr. 2009;12(4):444–54.PubMedCrossRef
19.
go back to reference Soares Magalhães RJ, Clements ACA. Mapping the risk of anaemia in preschool-age children: the contribution of malnutrition, malaria, and helminth infections in West Africa. PLOS Med. 2011;8(6):e1000438.PubMedCentralCrossRef Soares Magalhães RJ, Clements ACA. Mapping the risk of anaemia in preschool-age children: the contribution of malnutrition, malaria, and helminth infections in West Africa. PLOS Med. 2011;8(6):e1000438.PubMedCentralCrossRef
20.
go back to reference Szajewska H, Ruszczynski M, Chmielewska A. Effects of iron supplementation in nonanemic pregnant women, infants, and young children on the mental performance and psychomotor development of children: a systematic review of randomized controlled trials. Am J Clin Nutr. 2010;91(6):1684–90.PubMedCrossRef Szajewska H, Ruszczynski M, Chmielewska A. Effects of iron supplementation in nonanemic pregnant women, infants, and young children on the mental performance and psychomotor development of children: a systematic review of randomized controlled trials. Am J Clin Nutr. 2010;91(6):1684–90.PubMedCrossRef
21.
go back to reference Lozoff B, Jimenez E, Wolf AW. Long-term developmental outcome of infants with iron deficiency. N Engl J Med. 1991;325(10):687–94.PubMedCrossRef Lozoff B, Jimenez E, Wolf AW. Long-term developmental outcome of infants with iron deficiency. N Engl J Med. 1991;325(10):687–94.PubMedCrossRef
22.
go back to reference Halterman JS, Kaczorowski JM, Aligne CA, Auinger P, Szilagyi PG. Iron deficiency and cognitive achievement among school-aged children and adolescents in the United States. Pediatrics. 2001;107(6):1381–6.PubMedCrossRef Halterman JS, Kaczorowski JM, Aligne CA, Auinger P, Szilagyi PG. Iron deficiency and cognitive achievement among school-aged children and adolescents in the United States. Pediatrics. 2001;107(6):1381–6.PubMedCrossRef
23.
go back to reference McCann JC, Ames BN. An overview of evidence for a causal relation between iron deficiency during development and deficits in cognitive or behavioral function. Am J Clin Nutr. 2007;85(4):931–45.PubMedCrossRef McCann JC, Ames BN. An overview of evidence for a causal relation between iron deficiency during development and deficits in cognitive or behavioral function. Am J Clin Nutr. 2007;85(4):931–45.PubMedCrossRef
24.
go back to reference Eussen S, Alles M, Uijterschout L, Brus F, Van Der Horst-graat J. Iron intake and status of children aged 6–36 months in Europe: a systematic review. Ann Nutr Metab. 2015;66(2–3):80–92.PubMedCrossRef Eussen S, Alles M, Uijterschout L, Brus F, Van Der Horst-graat J. Iron intake and status of children aged 6–36 months in Europe: a systematic review. Ann Nutr Metab. 2015;66(2–3):80–92.PubMedCrossRef
25.
go back to reference Balarajan Y, Ramakrishnan U, Özaltin E, Shankar AH, Subramanian SV. Anaemia in low-income and middle-income countries. Lancet. 2011;378(9809):2123–35.PubMedCrossRef Balarajan Y, Ramakrishnan U, Özaltin E, Shankar AH, Subramanian SV. Anaemia in low-income and middle-income countries. Lancet. 2011;378(9809):2123–35.PubMedCrossRef
26.
go back to reference World Health Organization. WHO guideline: use of multiple micronutrient powders for point-of-use fortification of foods consumed by infants and young children aged 6–23 months and children aged 2–12 years. Geneva: World Health Organization; 2016. World Health Organization. WHO guideline: use of multiple micronutrient powders for point-of-use fortification of foods consumed by infants and young children aged 6–23 months and children aged 2–12 years. Geneva: World Health Organization; 2016.
27.
go back to reference Nutrition Co. Iron fortification of infant formulas. Pediatrics. 1999;104(1):119–23.CrossRef Nutrition Co. Iron fortification of infant formulas. Pediatrics. 1999;104(1):119–23.CrossRef
28.
go back to reference Hay G, Refsum H, Whitelaw A, Melbye EL, Haug E, Borch-Iohnsen B. Predictors of serum ferritin and serum soluble transferrin receptor in newborns and their associations with iron status during the first 2 y of life. Am J Clin Nutr. 2007;86(1):64–73.PubMedCrossRef Hay G, Refsum H, Whitelaw A, Melbye EL, Haug E, Borch-Iohnsen B. Predictors of serum ferritin and serum soluble transferrin receptor in newborns and their associations with iron status during the first 2 y of life. Am J Clin Nutr. 2007;86(1):64–73.PubMedCrossRef
29.
go back to reference Domellöf M, Lönnerdal B, Dewey KG, Cohen RJ, Rivera LL, Hernell O. Sex differences in iron status during infancy. Pediatrics. 2002;110(3):545–52.PubMedCrossRef Domellöf M, Lönnerdal B, Dewey KG, Cohen RJ, Rivera LL, Hernell O. Sex differences in iron status during infancy. Pediatrics. 2002;110(3):545–52.PubMedCrossRef
31.
go back to reference Jackson RT, Hamad NA, Al-Somaie M, Guoad NA, Prakash P. Gender and age differences in anemia prevalence during the lifecycle in Kuwait. Ecol Food Nutr. 2004;43(1–2):61–75.CrossRef Jackson RT, Hamad NA, Al-Somaie M, Guoad NA, Prakash P. Gender and age differences in anemia prevalence during the lifecycle in Kuwait. Ecol Food Nutr. 2004;43(1–2):61–75.CrossRef
32.
go back to reference Zhu Z, Sudfeld CR, Cheng Y, Qi Q, Li S, Elhoumed M, et al. Anemia and associated factors among adolescent girls and boys at 10–14 years in rural western China. BMC Public Health. 2021;21(1):1–14.CrossRef Zhu Z, Sudfeld CR, Cheng Y, Qi Q, Li S, Elhoumed M, et al. Anemia and associated factors among adolescent girls and boys at 10–14 years in rural western China. BMC Public Health. 2021;21(1):1–14.CrossRef
33.
go back to reference World Health Organization. Guideline: daily iron supplementation in adult women and adolescent girls. Geneva: World Health Organization, Geneva; 2016. World Health Organization. Guideline: daily iron supplementation in adult women and adolescent girls. Geneva: World Health Organization, Geneva; 2016.
36.
go back to reference Hsu C, McCulloch CE, Curhan GC. Epidemiology of anemia associated with chronic renal insufficiency among adults in the United States: results from the third national health and nutrition examination survey. J Am Soc Nephrol. 2002;13(2):504–10.PubMedCrossRef Hsu C, McCulloch CE, Curhan GC. Epidemiology of anemia associated with chronic renal insufficiency among adults in the United States: results from the third national health and nutrition examination survey. J Am Soc Nephrol. 2002;13(2):504–10.PubMedCrossRef
37.
go back to reference Nilsson-Ehle H, Jagenburg R, Landahl S, Svanborg A. Blood haemoglobin declines in the elderly: implications for reference intervals from age 70 to 88. Eur J Haematol. 2000;65(5):297–305.PubMedCrossRef Nilsson-Ehle H, Jagenburg R, Landahl S, Svanborg A. Blood haemoglobin declines in the elderly: implications for reference intervals from age 70 to 88. Eur J Haematol. 2000;65(5):297–305.PubMedCrossRef
38.
go back to reference Weatherall DJ. Keynote address: the challenge of thalassemia for the developing countries. Ann N Y Acad Sci. 2005;1054:11–7.PubMedCrossRef Weatherall DJ. Keynote address: the challenge of thalassemia for the developing countries. Ann N Y Acad Sci. 2005;1054:11–7.PubMedCrossRef
39.
go back to reference Weatherall DJ. Thalassemia as a global health problem: recent progress toward its control in the developing countries. Ann N Y Acad Sci. 2010;1202:17–23.PubMedCrossRef Weatherall DJ. Thalassemia as a global health problem: recent progress toward its control in the developing countries. Ann N Y Acad Sci. 2010;1202:17–23.PubMedCrossRef
40.
go back to reference Weatherall D, Akinyanju O, Fucharoen S, Olivieri N, Musgrove P. Inherited disorders of hemoglobin. In: Jamison DT, Breman JG, Measham AR, Alleyne G, Claeson M, Evans DB, Jha P, Mills A, Musgrove P, editors. Disease control priorities in developing countries. 2nd ed. Washington: World Bank Publications; 2006. Weatherall D, Akinyanju O, Fucharoen S, Olivieri N, Musgrove P. Inherited disorders of hemoglobin. In: Jamison DT, Breman JG, Measham AR, Alleyne G, Claeson M, Evans DB, Jha P, Mills A, Musgrove P, editors. Disease control priorities in developing countries. 2nd ed. Washington: World Bank Publications; 2006.
41.
go back to reference Hoppe CC. Prenatal and newborn screening for hemoglobinopathies. Int J Lab Hematol. 2013;35(3):297–305.PubMedCrossRef Hoppe CC. Prenatal and newborn screening for hemoglobinopathies. Int J Lab Hematol. 2013;35(3):297–305.PubMedCrossRef
42.
go back to reference Korenromp EL, Armstrong-Schellenberg JR, Williams BG, Nahlen BL, Snow RW. Impact of malaria control on childhood anaemia in Africa—a quantitative review. Trop Med Int Health TM IH. 2004;9(10):1050–65.PubMedCrossRef Korenromp EL, Armstrong-Schellenberg JR, Williams BG, Nahlen BL, Snow RW. Impact of malaria control on childhood anaemia in Africa—a quantitative review. Trop Med Int Health TM IH. 2004;9(10):1050–65.PubMedCrossRef
45.
go back to reference Torheim LE, Ferguson EL, Penrose K, Arimond M. Women in resource-poor settings are at risk of inadequate intakes of multiple micronutrients. J Nutr. 2010;140(11):2051S-S2058.PubMedCrossRef Torheim LE, Ferguson EL, Penrose K, Arimond M. Women in resource-poor settings are at risk of inadequate intakes of multiple micronutrients. J Nutr. 2010;140(11):2051S-S2058.PubMedCrossRef
46.
go back to reference Stevens GA, Bennett JE, Hennocq Q, Lu Y, De-Regil LM, Rogers L, et al. Trends and mortality effects of vitamin A deficiency in children in 138 low-income and middle-income countries between 1991 and 2013: a pooled analysis of population-based surveys. Lancet Glob Health. 2015;3(9):e528–36.PubMedCrossRef Stevens GA, Bennett JE, Hennocq Q, Lu Y, De-Regil LM, Rogers L, et al. Trends and mortality effects of vitamin A deficiency in children in 138 low-income and middle-income countries between 1991 and 2013: a pooled analysis of population-based surveys. Lancet Glob Health. 2015;3(9):e528–36.PubMedCrossRef
48.
go back to reference de Barros SF, Cardoso MA. Adherence to and acceptability of home fortification with vitamins and minerals in children aged 6 to 23 months: a systematic review. BMC Public Health. 2016;16(1):1–11.CrossRef de Barros SF, Cardoso MA. Adherence to and acceptability of home fortification with vitamins and minerals in children aged 6 to 23 months: a systematic review. BMC Public Health. 2016;16(1):1–11.CrossRef
49.
go back to reference World Health Organization. Nutritional anaemias: tools for effective prevention and control. Geneva: World Health Organization; 2017. World Health Organization. Nutritional anaemias: tools for effective prevention and control. Geneva: World Health Organization; 2017.
50.
go back to reference Horton S, Shekar M, McDonald C, Mahal A, Brooks JK. Scaling up nutrition: What will it cost? Washington: World Bank Publications; 2009.CrossRef Horton S, Shekar M, McDonald C, Mahal A, Brooks JK. Scaling up nutrition: What will it cost? Washington: World Bank Publications; 2009.CrossRef
53.
go back to reference Haider BA, Olofin I, Wang M, Spiegelman D, Ezzati M, Fawzi WW. Anaemia, prenatal iron use, and risk of adverse pregnancy outcomes: systematic review and meta-analysis. BMJ Br Med J. 2013;346:f3443.CrossRef Haider BA, Olofin I, Wang M, Spiegelman D, Ezzati M, Fawzi WW. Anaemia, prenatal iron use, and risk of adverse pregnancy outcomes: systematic review and meta-analysis. BMJ Br Med J. 2013;346:f3443.CrossRef
55.
go back to reference Black RE, Allen LH, Bhutta ZA, Caulfield LE, de Onis M, Ezzati M, et al. Maternal and child undernutrition: global and regional exposures and health consequences. Lancet. 2008;371(9608):243–60.PubMedCrossRef Black RE, Allen LH, Bhutta ZA, Caulfield LE, de Onis M, Ezzati M, et al. Maternal and child undernutrition: global and regional exposures and health consequences. Lancet. 2008;371(9608):243–60.PubMedCrossRef
57.
go back to reference Field MS, Mithra P, Peña-Rosas JP. Wheat flour fortification with iron and other micronutrients for reducing anaemia and improving iron status in populations. Cochrane Database Syst Rev. 2021;1:Cd011302.PubMed Field MS, Mithra P, Peña-Rosas JP. Wheat flour fortification with iron and other micronutrients for reducing anaemia and improving iron status in populations. Cochrane Database Syst Rev. 2021;1:Cd011302.PubMed
58.
go back to reference World Health Organization. Guideline: daily iron and folic acid supplementation in pregnant women. Geneva: World Health Organization; 2012. World Health Organization. Guideline: daily iron and folic acid supplementation in pregnant women. Geneva: World Health Organization; 2012.
60.
go back to reference Das JK, Salam RA, Kumar R, Bhutta ZA. Micronutrient fortification of food and its impact on woman and child health: a systematic review. Syst Rev. 2013;2(1):1–24.CrossRef Das JK, Salam RA, Kumar R, Bhutta ZA. Micronutrient fortification of food and its impact on woman and child health: a systematic review. Syst Rev. 2013;2(1):1–24.CrossRef
Metadata
Title
Burden of anemia and its underlying causes in 204 countries and territories, 1990–2019: results from the Global Burden of Disease Study 2019
Authors
Saeid Safiri
Ali-Asghar Kolahi
Maryam Noori
Seyed Aria Nejadghaderi
Nahid Karamzad
Nicola Luigi Bragazzi
Mark J. M. Sullman
Morteza Abdollahi
Gary S. Collins
Jay S. Kaufman
Jessica A. Grieger
Publication date
01-12-2021
Publisher
BioMed Central
Published in
Journal of Hematology & Oncology / Issue 1/2021
Electronic ISSN: 1756-8722
DOI
https://doi.org/10.1186/s13045-021-01202-2

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