Iron deficiency anemia-related mortality trends in US older subjects, 1999 to 2019

Previous investigations showed that the prevalence of iron deficiency is increasing in United States (US). However, data regarding iron deficiency anemia-related mortality trends are lacking. We assess the trends in iron deficiency anemia-related mortality in US adults aged 65 years or older over the last two decades.

Iron-deficiency anemia-related deaths were ascertained using ICD-10 codes in the Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research (CDC WONDER) database from 1999 to 2019. Age-adjusted mortality rates (AAMRs) were assessed using the Joinpoint regression modelling and expressed as estimated average annual percentage change (AAPC) and annual percent change (APC) with relative 95% confidence interval (95% CI), stratified by level of urbanization, sex, age, and race.

Between 1999 and 2019, 30,540 US subjects aged ≥ 65 years old (11,986 men and 18,554 women) equating to 77.8 deaths per 100,000 or 27.9 deaths per week, had iron deficiency anemia listed as a cause of death. The AAMR remained stable from 1999 to 2013 [APC: -0.3, (95%CI: -0.9 to 0.1, p = 0.11)] and then sharply increased from 2013 to 2019 [APC: +9.7% (95%CI: 7.8 to 11.6), p < 0.0001) without differences in sex, race, ethnicity or level of urbanization. The higher AAMRs were clustered in the Midwest [4.29 per 100,000 (95% CI: 4.20 to 4.38)] and in the South [3.35 per 100,000, 95% CI: 3.28 to 3.35)].

Over the last two decades the iron deficiency anemia-related mortality trends increased among US older subjects, without differences by sex, race, ethnicity or urbanicity.