Temporal Trends and Racial Disparities in Iron Deficiency Anemia-Related Mortality in the United States and Texas (1999-2020): Insights from CDC Wonder
Authors: Naz Sidra , Yousaf Muhammad Sheraz , Taqdees Aqsa , Jose Thulasee 
Published: December 2024

Introduction: Iron deficiency anemia (IDA), is the leading cause of anemia accounting for 50% of all cases, posing a substantial public health challenge affecting various populations across the United States as its related mortality rates increase. This study seeks to evaluate the annual trends in IDA-related mortality in the United States and Texas, spanning from 1999 to 2020 while identifying associated sociodemographic factors. The goal is to assess public health initiatives and inform future prevention and treatment strategies.

Methods: The mortality trends among adults aged ≥25 with IDA were analyzed using data from the Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiological Research (CDC WONDER) database, where IDA was presented as a contributing or the underlying cause of death. Code D50.9 “Iron deficiency anemia” in the International Classification of Disease, tenth revision (ICD-10) was used to identify the data. Crude and age-adjusted mortality rates (AAMRs) per 100,000 people were extracted. Annual percent changes (APCs) in AAMRs with 95% CI were obtained using joint point regression analysis across different demographic (sex, race/ethnicity, and age) and geographic (state, urban-rural, and regional) subgroups.

Results: Between 1999 and 2020,19769 documented deaths were attributed to IDA. The overall AAMR for IDA-related mortality decreased in the US from an adjusted rate (AR) 0.4 in 1999 to 0.3 in 2012 (APC: -3.19%; 95% CI: -1.85% to -5.09%), after which it increased to 0.8 in 2020 (APC: 13.89%; 95% CI: 17.32% to 11.69%). In Texas AAMR for IDA-related mortality increased from AR 0.4 in 1999 to 1.1 in 2020 (APC: 4.87%; 95% CI: 6.60% to 3.51%). Females had higher consistently higher AAMRs than males (0.8 vs. 0.6). The AAMR in the US women decreased from 0.4 in 1999 to 0.3 in 2013 (APC: -2.44%; 95% CI: -1.08% to -4.18%) after which it increased to 0.8 in 2020 (APC: 14.8%; 95% CI: 18.9% to 11.9%). The AAMR in the US men decreased from 0.3 in 1999 to 0.2 in 2013 (APC: -1.35%; 95% CI: -3.49% to 0.30%) after which it increased to 0.6 in 2020 (APC: 14.7%; 95% CI: 19.5% to 11.6%). The non-Hispanic (NH) Black or African American (AA) population has the greatest AAMR (0.9), followed by the NH White population (0.8) and the Hispanic or Latino population with AAMR (0.7). The low-risk population was NH Asian or Pacific Islander (0.4) and NH American Indian or Alaska Native with AAMR (0.3). AAMR also varied by region (overall AAMR: Midwest:1; West: 0.7; Northeast:0.7; South:0.6) and non-metropolitan areas had higher AAMR (non-core areas:1.2; micropolitan areas:1) than metropolitan areas (large central metropolitan areas:0.6; large fringe areas:0.5). The states in the upper 90th percentile of IDA-related AAMRs were Tennessee, North Carolina, Maryland, Pennsylvania, Michigan, Missouri and Ohio exhibited an approximately two-fold increase in AAMRs, compared to states falling in the lower 10th percentile.

Conclusions: Over the last two decades, there has been an overall rise in mortality related to iron deficiency anemia in the United States and Texas. However, demographic and geographic discrepancies in IDA-related mortality persist, necessitating additional exploration and development of specifically directed treatments.