Data needed to respond appropriately to anemia when it is a public health problem

Abstract

Although the proportion of anemia amenable to change varies by population, the World Health Organization (WHO) criteria used to describe the public health severity of anemia are based on population prevalences. We describe the importance of measuring iron and other etiologic indicators to better understand what proportion of anemia could be responsive to interventions. We discuss the necessity of measuring inflammation to interpret iron biomarkers and documenting anemia of inflammation. Finally, we suggest assessing nonmodifiable genetic blood disorders associated with anemia. Using aggregated results from the Global Burden of Disease 2016, we compare population prevalence of anemia with years lived with disability (YLD) estimates, and the relative contributions of mild, moderate, and severe anemia to YLD. Anemia prevalences correlated with YLD and the relative proportion of moderate or severe anemia increased with anemia prevalence. However, individual-level survey data revealed irregular patterns between anemia prevalence, the prevalence of moderate or severe anemia, and the prevalence of iron deficiency anemia (IDA). We conclude that although the WHO population prevalence criteria used to describe the public health severity of anemia are important for policymaking, etiologic-specific metrics that take into account IDA and other causes will be necessary for effective anemia control policies.

Keywords: anemia; disability-adjusted life years; iron deficiency anemia; public health significance.

Figure 1.

Country-level anemia prevalence rate by YLD rate for 2016 by WHO regions. Note: Global Health Data Exchange estimates of years lived with disability (YLD, per 100,000) from anemia and anemia prevalence rate (per 100) among all age groups (women and men at all available ages), children under 5 years, adolescent females (10–19 years old), and women of reproductive age (15–49 years old). World Health Organization (WHO) regions are designated by color; each dot represents a unique country.

Figure 2.

Age-standardized 2016 YLD rate according to the severity of anemia among children under 5 years (A) and adults 15–49 years old (B) stratified by gender and WHO region. Note: Global health data exchange estimates of anemia years lived with disability (YLD, per 100,000) and anemia severity among children under 5 years and adults 15–49 years old (World Health Organization (WHO)).