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. 2023 Sep;10(9):e713-e734.
doi: 10.1016/S2352-3026(23)00160-6. Epub 2023 Jul 31.

Prevalence, years lived with disability, and trends in anaemia burden by severity and cause, 1990-2021: findings from the Global Burden of Disease Study 2021

GBD 2021 Anaemia Collaborators
Collaborators

Prevalence, years lived with disability, and trends in anaemia burden by severity and cause, 1990-2021: findings from the Global Burden of Disease Study 2021

GBD 2021 Anaemia Collaborators. Lancet Haematol. 2023 Sep.

Erratum in

Abstract

Background: Anaemia is a major health problem worldwide. Global estimates of anaemia burden are crucial for developing appropriate interventions to meet current international targets for disease mitigation. We describe the prevalence, years lived with disability, and trends of anaemia and its underlying causes in 204 countries and territories.

Methods: We estimated population-level distributions of haemoglobin concentration by age and sex for each location from 1990 to 2021. We then calculated anaemia burden by severity and associated years lived with disability (YLDs). With data on prevalence of the causes of anaemia and associated cause-specific shifts in haemoglobin concentrations, we modelled the proportion of anaemia attributed to 37 underlying causes for all locations, years, and demographics in the Global Burden of Disease Study 2021.

Findings: In 2021, the global prevalence of anaemia across all ages was 24·3% (95% uncertainty interval [UI] 23·9-24·7), corresponding to 1·92 billion (1·89-1·95) prevalent cases, compared with a prevalence of 28·2% (27·8-28·5) and 1·50 billion (1·48-1·52) prevalent cases in 1990. Large variations were observed in anaemia burden by age, sex, and geography, with children younger than 5 years, women, and countries in sub-Saharan Africa and south Asia being particularly affected. Anaemia caused 52·0 million (35·1-75·1) YLDs in 2021, and the YLD rate due to anaemia declined with increasing Socio-demographic Index. The most common causes of anaemia YLDs in 2021 were dietary iron deficiency (cause-specific anaemia YLD rate per 100 000 population: 422·4 [95% UI 286·1-612·9]), haemoglobinopathies and haemolytic anaemias (89·0 [58·2-123·7]), and other neglected tropical diseases (36·3 [24·4-52·8]), collectively accounting for 84·7% (84·1-85·2) of anaemia YLDs.

Interpretation: Anaemia remains a substantial global health challenge, with persistent disparities according to age, sex, and geography. Estimates of cause-specific anaemia burden can be used to design locally relevant health interventions aimed at improving anaemia management and prevention.

Funding: Bill & Melinda Gates Foundation.

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Conflict of interest statement

Declaration of interests S Afzal reports participation on a data safety monitoring board or advisory board with the National Bioethics Committee of Pakistan, King Edward Medical University Institutional Review Board, and the Ethics Review Board in Board of Studies; a leadership or fiduciary role with the Pakistan Association of Medical Editors, as a Fellow of Faculty of Public Health (FFPH) Royal Colleges UK, and an advocacy role in the Society of Prevention and Advocacy Research with King Edward Medical University, Lahore, Pakistan, all outside the submitted work. R Agustina reports leadership or fiduciary roles with the Multiple Micronutrient Supplementation Technical Advisory Group of the New York Academy of Sciences and with the Indonesia Technical Advisory Board for Multimicronutrient Supplemenation, outside the submitted work. R Ancuceanu reports payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events from AbbVie, Sandoz, B Braun, and Laropharm, outside the submitted work. S Das is a member of the Personalized Medicine Division of the American Association of Clinical Chemistry and a member of the Royal College of Biology; and reports other financial interests through a research grant of 1·6 million INR from the Department of Science and Technology, Government of India; all outside the submitted work. C Hennessy reports support for the present work from the Institute for Health Metrics and Evaluation and the Center for Health System Effectiveness. N E Ismail is a council member of the Malaysian Academy of Pharmacy, outside the submitted work. J J Jozwiak reports payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events from Novartis and Adamed as personal payments, outside the submitted work. N J Kassebaum reports support for this manuscript from the Bill & Melinda Gates Foundation as grant payments to their institution (Institute of Health Metrics and Evaluation, University of Washington, Seattle, WA, USA). K Krishan reports non-financial support from UGC Centre of Advanced Study, CAS II, Department of Anthropology, Panjab University, Chandigarh, India, outside the submitted work. W Mendoza is a staff member at the UNFPA Peru Country Office, which does not necessarily endorse these results. A-F A Mentis reports grants or contracts from MilkSafe: a novel pipeline to enrich formula milk using omics technologies, a project co-financed by the European Regional Development Fund of the European Union and Greek national funds through the Operational Program Competitiveness, Entrepreneurship and Innovation, under the call RESEARCH – CREATE – INNOVATE (project code T2EDK-02222) and from ELIDEK (Hellenic Foundation for Research and Innovation, MIMS-860); has received payment for expert testimony as a peer-reviewer for Fondazione Cariplo, Italy; serves as an editorial board member for the journals Systematic Reviews and Annals of Epidemiology, and as an Associate Editor for Translational Psychiatry; and is a scientific officer with the BGI Group; all outside the submitted work. N Moka is Treasurer of the Kentucky Society of Clinical Oncology, outside the submitted work. A Ortiz reports grants or contracts from Sanofi as payments to their institution (IIS-Fundacion Jiménez Díaz UAM, Madrid, Spain); consulting fees from Advicienne, Astellas Pharma, AstraZeneca, Amicus Therapeutics, Amgen, Boehringer Ingelheim, Fresenius Medical Care, GSK, Bayer, Sanofi-Genzyme, Menarini, Mundipharma, Kyowa Kirin, Lilly, Alexion Pharmaceuticals, Freeline Therapeutics, Idorsia, Chiesi, Otsuka Pharmaceutical, Novo Nordisk, Sysmex, and Vifor Fresenius Medical Care Renal Pharma; support for travel from Advicienne, Astellas Pharma, AstraZeneca, Amicus Therapeutics, Amgen, Boehringer Ingelheim, Fresenius Medical Care, GSK, Bayer, Sanofi-Genzyme, Menarini, Mundipharma, Kyowa Kirin, Lilly, Alexion Pharmaceuticals, Freeline Therapeutics, Idorsia, Chiesi, Otsuka Pharmaceutical, Novo Nordisk, Sysmex, and Vifor Fresenius Medical Care Renal Pharma; a leadership or fiduciary role with the European Renal Association, a role as Director of the Catedra Mundipharma-UAM of diabetic kidney disease and the Catedra AstraZeneca-UAM of chronic kidney disease and electrolytes; and stock or stock options in Telara Pharma; all outside the submitted work. Z Quazi Syed reports support for this manuscript from the South Asia Infant Feeding Research Network and Datta Meghe Institute of Higher Education and Research, Wardha, India; grants or contracts from the Global Consortium for Public Health and Research and Datta Meghe Institute of Higher Education and Research; support for attending meetings and/or travel from the Division of Evidence Synthesis, Jawaharlal Nehru Medical College, Wardha, India, and Datta Meghe Institute of Medical Sciences, Wardha, India, outside the submitted work. T Richards reports grants or contracts from Vifor Pharma for PREVENT laboratory analysis; consulting fees from BioAge Labs for a clinical trial design; payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events from Pharmacosmos through the CAVIAR education grant and from Pfizer for the IRONWOMAN trial; support for attending meetings from Pfizer, Pharmacosmos, and Vifor Pharma; a role as treasurer with NATA; and a role as Director of The Iron Clinic; all outside the submitted work. V Shivarov is an employee of ICON and reports stock or stock options in the company, all outside the submitted work. J A Singh reports consulting fees from Crealta/Horizon, MediSys, Fidia Farmaceutici, PK Med, Two Labs, Adept Field Solutions, Clinical Care Options, Clearview Healthcare Partners, Putnam Associates, Focus Forward, Navigant Consulting, Spherix Global Insights, Mediq, Jupiter Life Science, UBM, Trio Health, Medscape, WebMD, and Practice Point Communications, the National Institutes of Health, and the American College of Rheumatology; payment or honoraria for speakers bureaus from Simply Speaking; support for attending meetings or travel from the steering committee of OMERACT; participation on a data safety monitoring board or advisory board with the US Food and Drug Administration Arthritis Advisory Committee; membership of the steering committee of OMERACT, a role as Chair (unpaid) of the Veterans Affairs Rheumatology Field Advisory Committee, and roles as Editor and Director (unpaid) with the UAB Cochrane Musculoskeletal Group Satellite Center on Network Meta-analysis; stock or stock options in TPT Global Tech, Vaxart Pharmaceuticals, Aytu BioPharma, Adaptimmune Therapeutics, GeoVax Labs, Pieris Pharmaceuticals, Enzolytics, Seres Therapeutics, Tonix Pharmaceuticals, and Charlotte's Web Holdings, and previous stock options in Amarin, Viking Therapeutics, and Moderna Pharmaceuticals; all outside the submitted work. J D Stanaway reports support for this manuscript from the Bill & Melinda Gates Foundation as grants to their institution (Institute of Health Metrics and Evaluation, University of Washington, Seattle, WA, USA). P S Suchdev reports grants or contracts from the Centers for Disease Control and Prevention (CDC) and the Bill & Melinda Gates Foundation, all outside the submitted work. M F Young reports grants from the Bill & Melinda Gates Foundation and the CDC for a project titled Biomarkers reflecting inflammation and nutritional determinants of anemia (BRINDA) and from the National Institutes of Health for a project titled Mother–child hemoglobin at preconception and first 1000 days and child development at 6 years; roles in the Lancet Haematology Commission on anaemia, the Anaemia Evidence Gap Map Advisory Group, as a subject matter expert on the advisory committee related to the Improving Estimates of Anemia in Global Burden of Disease research project, as a member of the technical advisory group for the Redefining Maternal Anaemia in Pregnancy and Postpartum project and a member of the WHO Guideline Development Group for Anemia; all outside the submitted work. All other authors declare no competing interests.

Figures

Figure 1
Figure 1
Anaemia prevalence and YLDs (rate per 100 000 population) (A) Global anaemia prevalence by severity for all ages and male and female sexes, 1990–2021. (B) YLDs (rate per 100 000 population) by severity for all ages and male and female sexes, 1990–2021. (C) Global anaemia prevalence (top) and YLDs (rate per 100 000 population; bottom) for all ages and male and female sexes in 2021. Error bars are 95% CI. (D) Percentage change between 1990 and 2021 in anaemia prevalence (top) and YLDs (rate per 100 000 population; bottom) for all ages and male and female sexes. Error bars are 95% CI. YLDs=years lived with disability.
Figure 2
Figure 2
All-ages anaemia burden, 2021 (A) Anaemia prevalence for all ages and male and female sexes, 2021. (B) Anaemia YLDs (rate per 100 000 population) for all ages and male and female sexes, 2021. (C) Observed-to-expected ratio for YLD rate per 100 000 population for all ages and male and female sexes, 2021. Expected values were based on Socio-demographic Index. (D) Male-to-female ratio for YLD rate per 100,000 population, 2021. YLDs=years lived with disability.
Figure 3
Figure 3
Causes of anaemia ranked by all-ages YLD rate, globally and by super-region, in males and females in 1990 and 2021 YLDs=years lived with disability.
Figure 4
Figure 4
Global distribution of anaemia causes (A) Cause-specific anaemia prevalence by age, for male and female sexes, 2021. (B) Percentage change in YLDs versus the percentage change in cause prevalence, all ages, for male and female sexes, 1990–2021. (C) Cause-specific anaemia YLD rate per 100 000 population by age, for males, 2021. (D) Cause-specific anaemia YLD rate per 100 000 population by age, for females, 2021. CKD=chronic kidney disease. Endocrine=endocrine, metabolic, blood, and immune disorders. G6PD=glucose-6-phosphate dehydrogenase. NTD=neglected tropical diseases. P falciparum=Plasmodium falciparum. P vivax=Plasmodium vivax. YLDs=years lived with disability.
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Comment in

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