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, Nicholas J. KASSEBAUM*, Edward Kwabena AMEYAW

*Corresponding author for this work

Research output: Journal PublicationsJournal Article (refereed)peer-review

32 Citations (Scopus)

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.
Original languageEnglish
Pages (from-to)e713-e734
JournalThe Lancet Haematology
Volume10
Issue number9
Early online date31 Jul 2023
DOIs
Publication statusPublished - Sept 2023

Bibliographical note

Funding Information:
This project was supported by the Bill & Melinda Gates Foundation. S Afzal acknowledges support from the Department of Community Medicine and Epidemiology, King Edward Medical University, Lahore, Pakistan. A Ahmad acknowledges Shaqra University, Shaqra, Saudi Arabia for supporting this work. A Badawi is supported by the Public Health Agency of Canada. L Belo acknowledges the support from Fundação para a Ciência e a Tecnologia in the scope of the project UIDP/04378/2020 and UIDB/04378/2020 of UCIBIO and the project LA/P/0140/2020 of i4HB. A Fatehizadeh acknowledges support from the Department of Environmental Health Engineering, Isfahan University of Medical Sciences, Isfahan, Iran. S Gaihre acknowledges the Institute of Applied Health Sciences, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK for their institutional support. J C Glasbey is supported by a National Institute for Health and Care Research Doctoral Research Fellowship (NIHR300175). V K Gupta acknowledges funding support from the National Health and Medical Research Council (NHMRC), Australia. S Hussain was supported by Operational Program Research, Development and Education project Postdoc2MUNI (number CZ.02.2.69/0.0/0.0/18_053/0016952). S M S Islam is funded by the NHMRC and has received funding from the National Heart Foundation of Australia. N Joseph acknowledges support from the Department of Community Medicine, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, India. H Kandel is supported by a Kornhauser Research Fellowship at The University of Sydney, Sydney, NSW, Australia. Y J Kim was supported by the Research Management Centre, Xiamen University Malaysia, Sepang, Malaysia (grant numbers XMUMRF/2020-C6/ITCM/0004]. S L Koulmane Laxminarayana acknowledges institutional support from Manipal Academy of Higher Education, Manipal, India. K Krishan acknowledges non-financial support from UGC Centre of Advanced Study, CAS II, Department of Anthropology, Panjab University, Chandigarh, India. I Landires acknowledges support from Sistema Nacional de Investigación, which is supported by Panama's Secretaría Nacional de Ciencia, Tecnología e Innovación. K Latief acknowledges funding from Taipei Medical University, Taipei, Taiwan for doctoral education during the conduct of this review. D C Malta acknowledges support from Conselho Nacional de Pesquisas (CNPq), Brazil. L Monasta received support from the Italian Ministry of Health (Ricerca Corrente 34/2017) as payments made to the Institute for Maternal and Child Health - IRCCS Burlo Garofolo, Trieste, Italy. A Ortiz was supported by Instituto de Salud Carlos III RICORS programme to RICORS2040 (RD21/0005/0001) funded by European Union – NextGenerationEU, Mecanismo para la Recuperación y la Resiliencia and SPACKDc PMP21/00109, FEDER funds. J R Padubidri, A Shetty, B S K Shetty, P H Shetty, and B Unnikrishnan acknowledge the support given by Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, India. T Palicz acknowledges support from the National Research, Development and Innovation Office in Hungary (RRF-2.3.1-21-2022-00006, Data-Driven Health Division of National Laboratory for Health Security). G Pereira was supported with funding from NHMRC Project and Investigator Grants (1099655 and 1173991). Z Z Piracha acknowledges the International Center of Medical Sciences Research, Islamabad, Pakistan. Z Quazi Syed acknowledges support from the South Asia Infant Feeding Research Network and Datta Meghe Institute of Higher Education and Research, Wardha, India. A Rahman acknowledges Charles Sturt University, Wagga Wagga, NSW, Australia. U Saeed acknowledges the International Center of Medical Sciences Research, Islamabad, Pakistan. A M Samy acknowledges the support from Ain Shams University, Cairo, Egypt and the Egyptian Fulbright Mission Program. P A Shah acknowledges the support from Bangalore Medical College and Research Institute, part of the Rajiv Gandhi University of Health Sciences, Bangalore, India. M R Tovani-Palone acknowledges support from Saveetha Institute of Medical and Technical Sciences, Chennai, India. D Vervoort is supported by the Canadian Institutes of Health Research Vanier Canada Graduate Scholarship. X Xu is supported by a postdoctoral fellowship funded by the Heart Foundation of Australia (award number 102597) and Scientia Program at the University of New South Wales, Sydney, NSW, Australia. C Yu acknowledges support from the National Natural Science Foundation of China (grant number 82173626).

Funding Information:
This project was supported by the Bill & Melinda Gates Foundation. S Afzal acknowledges support from the Department of Community Medicine and Epidemiology, King Edward Medical University, Lahore, Pakistan. A Ahmad acknowledges Shaqra University, Shaqra, Saudi Arabia for supporting this work. A Badawi is supported by the Public Health Agency of Canada. L Belo acknowledges the support from Fundação para a Ciência e a Tecnologia in the scope of the project UIDP/04378/2020 and UIDB/04378/2020 of UCIBIO and the project LA/P/0140/2020 of i4HB. A Fatehizadeh acknowledges support from the Department of Environmental Health Engineering, Isfahan University of Medical Sciences, Isfahan, Iran. S Gaihre acknowledges the Institute of Applied Health Sciences, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK for their institutional support. J C Glasbey is supported by a National Institute for Health and Care Research Doctoral Research Fellowship (NIHR300175). V K Gupta acknowledges funding support from the National Health and Medical Research Council (NHMRC), Australia. S Hussain was supported by Operational Program Research, Development and Education project Postdoc2MUNI (number CZ.02.2.69/0.0/0.0/18_053/0016952). S M S Islam is funded by the NHMRC and has received funding from the National Heart Foundation of Australia. N Joseph acknowledges support from the Department of Community Medicine, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, India. H Kandel is supported by a Kornhauser Research Fellowship at The University of Sydney, Sydney, NSW, Australia. Y J Kim was supported by the Research Management Centre, Xiamen University Malaysia, Sepang, Malaysia (grant numbers XMUMRF/2020-C6/ITCM/0004]. S L Koulmane Laxminarayana acknowledges institutional support from Manipal Academy of Higher Education, Manipal, India. K Krishan acknowledges non-financial support from UGC Centre of Advanced Study, CAS II, Department of Anthropology, Panjab University, Chandigarh, India. I Landires acknowledges support from Sistema Nacional de Investigación, which is supported by Panama's Secretaría Nacional de Ciencia, Tecnología e Innovación. K Latief acknowledges funding from Taipei Medical University, Taipei, Taiwan for doctoral education during the conduct of this review. D C Malta acknowledges support from Conselho Nacional de Pesquisas (CNPq), Brazil. L Monasta received support from the Italian Ministry of Health (Ricerca Corrente 34/2017) as payments made to the Institute for Maternal and Child Health - IRCCS Burlo Garofolo, Trieste, Italy. A Ortiz was supported by Instituto de Salud Carlos III RICORS programme to RICORS2040 (RD21/0005/0001) funded by European Union – NextGenerationEU, Mecanismo para la Recuperación y la Resiliencia and SPACKDc PMP21/00109, FEDER funds. J R Padubidri, A Shetty, B S K Shetty, P H Shetty, and B Unnikrishnan acknowledge the support given by Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, India. T Palicz acknowledges support from the National Research, Development and Innovation Office in Hungary (RRF-2.3.1-21-2022-00006, Data-Driven Health Division of National Laboratory for Health Security). G Pereira was supported with funding from NHMRC Project and Investigator Grants (1099655 and 1173991). Z Z Piracha acknowledges the International Center of Medical Sciences Research, Islamabad, Pakistan. Z Quazi Syed acknowledges support from the South Asia Infant Feeding Research Network and Datta Meghe Institute of Higher Education and Research, Wardha, India. A Rahman acknowledges Charles Sturt University, Wagga Wagga, NSW, Australia. U Saeed acknowledges the International Center of Medical Sciences Research, Islamabad, Pakistan. A M Samy acknowledges the support from Ain Shams University, Cairo, Egypt and the Egyptian Fulbright Mission Program. P A Shah acknowledges the support from Bangalore Medical College and Research Institute, part of the Rajiv Gandhi University of Health Sciences, Bangalore, India. M R Tovani-Palone acknowledges support from Saveetha Institute of Medical and Technical Sciences, Chennai, India. D Vervoort is supported by the Canadian Institutes of Health Research Vanier Canada Graduate Scholarship. X Xu is supported by a postdoctoral fellowship funded by the Heart Foundation of Australia (award number 102597) and Scientia Program at the University of New South Wales, Sydney, NSW, Australia. C Yu acknowledges support from the National Natural Science Foundation of China (grant number 82173626).

Publisher Copyright:
© 2023 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license

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