Iron deficiency represents a significant yet often neglected health issue that disproportionately affects women, girls, and individuals in low- and middle-income countries (LMICs). While anemia affects nearly 25% of the global population, the prevalence of iron deficiency could be twice as high, underscoring the gravity of this public health challenge and its implications for equitable health care.
Diagnosis and Treatment Challenges
The underdiagnosis and inadequate management of iron deficiency can lead to persistent health problems. A recent in-depth study published in Blood Advances, which analyzed data from 13,084 patients across the United States with verifiable iron deficiency, revealed a startling finding: 58% of those diagnosed did not see their deficiency resolved within three years, despite undergoing repeated ferritin testing. On average, those who did recover took nearly two years, indicating the slow and often frustrating journey toward improvement.
Differentiating the effects of iron deficiency from anemia adds to the complexity of patient care. Individuals struggling with iron deficiency frequently report debilitating symptoms such as profound fatigue, reduced exercise tolerance, and cognitive impairments. The stakes are even higher for pregnant individuals, as iron deficiency has been linked to negative neurodevelopmental outcomes in their infants, emphasizing the urgent need for effective interventions.
Disproportionate Burden and Barriers to Treatment
Recent research has brought to light striking disparities regarding the prevalence of iron deficiency. An investigation conducted in September 2024 estimated that a significant 14% of adults in the United States suffer from absolute iron deficiency, while another 15% experience functional iron deficiency. Among women aged 18 to 50 years, the figures are particularly alarming, with the prevalence of absolute iron deficiency soaring to 34%, and functional iron deficiency being more pronounced in older women and men across all age demographics.
Factors that contribute to this increased vulnerability among women and girls include menstruation and pregnancy, which elevate their risk for absolute iron deficiency. Moreover, the under-recognition of rare blood disorders such as hemophilia heightens these risks, complicating the landscape of diagnosis and treatment.
A significant gap exists in the testing of hemophilia treatments in clinical trials, which predominantly focus on male subjects. This oversight restricts treatment options for women, who may experience different hormonal dynamics. Margaret Ragni, MD, MPH, a prominent hematology expert from the University of Pittsburgh and director of the Hemophilia Center of Western Pennsylvania, shed light on this disparity in an interview with The American Journal of Managed Care® (AJMC®) Center on Health Equity & Access.
Current treatment strategies for iron deficiency often include oral iron supplements and intravenous iron therapy. While oral iron supplements are generally cost-effective, gastrointestinal side effects can pose significant challenges for many patients. Conversely, while intravenous iron therapy is regarded as a safe and effective option, barriers such as accessibility issues and financial constraints can inhibit patient access to this critical form of treatment.
Management of functional iron deficiency typically involves addressing the underlying inflammatory conditions, complicating the treatment approach. In LMICs, additional challenges compound the issue. Food insecurity, untreated heavy menstrual bleeding, and an uptick in inflammatory disorders such as obesity significantly contribute to the prevalence of iron deficiency. This widespread condition serves not only as a health concern but also as a glaring indicator of broader systemic health inequities and unmet nutritional needs.
Iron Deficiency: A Marker of Inequality
The growing body of research underscores the extensive nature of iron deficiency and the significant obstacles faced in its diagnosis and treatment, particularly among women. This heightened awareness necessitates actionable changes within healthcare systems to facilitate timely and effective diagnosis and management protocols.
The urgency for improved diagnostic criteria cannot be overstated, as there is a critical need to raise ferritin cutoff levels and incorporate assessments for functional iron deficiency. It is equally vital to broaden the availability of treatments, particularly intravenous iron, while also addressing the root causes of inadequate iron intake and absorption that lay at the heart of this critical issue.
References
1. The Lancet Haematology. Iron deficiency as a marker of inequality. Lancet Haematol. 2024;11(11):e803. doi:10.1016/S2352-3026(24)00318-1
2. Cogan J, Meyer J, Jiang Z, Sholzberg M. Iron deficiency resolution and time to resolution in an American health system. Blood Adv. 2024; bloodadvances.2024013197. doi:10.1182/bloodadvances.2024013197
3. Grossi G. Breaking barriers in bleeding disorders: experts call for more data on women. Am J Accountable Care. 2024;12(1):38-40. doi:10.37765/ajac.2024.89525
How can healthcare systems improve screening and treatment protocols for iron deficiency in vulnerable populations?
**Interview with Dr. Margaret Ragni on Iron Deficiency and Its Public Health Implications**
**Editor:** Welcome, Dr. Ragni, and thank you for joining us today to discuss the important issue of iron deficiency. This topic has significant implications, especially regarding health equity, as it disproportionately affects women, girls, and individuals in low- and middle-income countries (LMICs). Can you start by explaining why iron deficiency is often overlooked despite being such a prevalent issue?
**Dr. Ragni:** Thank you for having me. Iron deficiency is indeed a major global health concern that often goes under the radar. While anemia affects about 25% of the world’s population, research suggests that the prevalence of iron deficiency can be twice that figure. This disparity highlights a systemic issue in healthcare where the focus is primarily on diagnosing and treating anemia rather than understanding the underlying causes like iron deficiency. This oversight can lead to chronic health issues for many, especially in vulnerable populations [[1](https://www.mayoclinic.org/diseases-conditions/anemia/symptoms-causes/syc-20351360)].
**Editor:** That’s a critical point. A recent study published in *Blood Advances* revealed that a staggering 58% of patients diagnosed with iron deficiency did not have their condition resolved within three years. Why do you think this is the case?
**Dr. Ragni:** There are several factors involved. One is underdiagnosis; many healthcare providers might not screen for iron deficiency unless symptoms are severe. Additionally, the journey toward resolution can be slow and frustrating due to the need for careful monitoring of ferritin levels and managing the patient’s symptoms over time. This can be complicated by the challenges of differentiating between iron deficiency and anemia, as patients may report serious symptoms like fatigue and cognitive impairments. For pregnant women, the stakes are even higher since iron deficiency can adversely affect fetal neurodevelopment [[1](https://www.mayoclinic.org/diseases-conditions/anemia/symptoms-causes/syc-20351360)].
**Editor:** Absolutely. The statistics surrounding women, especially those aged 18 to 50, are alarming. Can you elaborate on the specific factors that increase their vulnerability to iron deficiency?
**Dr. Ragni:** Certainly. The monthly loss of blood during menstruation contributes significantly to iron loss, and pregnancy places additional demands on a woman’s iron stores. Unfortunately, these physiological needs are often not met due to dietary habits or lack of supplementation, particularly in LMICs where food insecurity is a prevalent issue. Moreover, underrecognized blood disorders, such as hemophilia, further complicate the landscape, as many clinical trials have historically focused on male subjects, leading to gaps in research and treatment options for women [[1](https://www.mayoclinic.org/diseases-conditions/anemia/symptoms-causes/syc-20351360)].
**Editor:** That’s an important insight about the gender disparities in medical research. Moving on to treatment options, what are the main strategies currently available for managing iron deficiency, and what obstacles do patients face in accessing these treatments?
**Dr. Ragni:** Current treatments typically include oral iron supplements and intravenous iron therapy. While oral supplements can be cost-effective, they often lead to gastrointestinal side effects, making compliance a challenge. Intravenous iron is effective and generally well-tolerated but can be limited by access issues and financial constraints in both high- and low-income settings. In LMICs, additional barriers include food insecurity and untreated menstrual health issues, which exacerbate the epidemic of iron deficiency [[1](https://www.mayoclinic.org/diseases-conditions/anemia/symptoms-causes/syc-20351360)].
**Editor:** Thank you for shedding light on these multifaceted challenges. As we conclude, what message would you like to share with our audience regarding iron deficiency and its broader implications for public health?
**Dr. Ragni:** It’s crucial that we bring increased awareness to iron deficiency, recognizing it not just as a medical issue but as a significant public health challenge that requires equitable solutions. Addressing barriers to diagnosis and treatment, especially for women and vulnerable populations, is essential. We need to advocate for better screening practices, more inclusive research, and improved access to both preventive and therapeutic measures. Only then can we hope to make substantial progress in tackling the global burden of iron deficiency [[1](https://www.mayoclinic.org/diseases-conditions/anemia/symptoms-causes/syc-20351360)].
**Editor:** Thank you, Dr. Ragni, for your valuable insights. It’s clear that addressing iron deficiency is imperative for improving health outcomes, especially for those most at risk. We appreciate your time and expertise today.