Prevalence

Mean hemoglobin concentration for all U.S. males older than 1 year is 14.67 g/dL, and for females older than 1 year, 13.19 g/dL (NHANES-III; NCHS, 2005b). These values vary by ethnic group; non-Hispanic white males had mean Hb of 14.05 g/dL, versus 13.87 g/dL for Mexican Americans and 13.14 g/dL for African Americans. Hb values for African American men and women are 1 g/dL lower than their white counterparts. The median Hb concentration was the same for both genders in all race and ethnic groups younger than 9 years. Mean Hb level tends to peak at 15.4 g/dL between ages 20 and 29 years and decreases to 14.36 g/dL by age 70. Anemia is defined as Hb level more than 2 standard deviations (SD) from the mean for age and race for the entire population.

The most prevalent cause of anemia in the United States is iron deficiency. Table 39-2 categorizes the prevalence of iron deficiency and iron deficiency anemia (NHANES-III,

Table 39-2 Prevalence of Iron Deficiency and Iron Deficiency Anemia—United States

Age Group (yr)

Deficiency

Anemia

1988-1994

1999-2000

1988-1994

1999-2000

Both genders

1-2

9%

7%

3%

2%*

3-5

3%

5%

6-11

2%

4%

Males

12-15

1%*

5%t

16-69

1%t

2%t

>70

4%

3%*

Females

12-49

11%

12%

4%

3%

12-15

9%

9%

2% (12-19)

2% (12-19)

16-19

11%

16%

20-49

11%

12%

5%

50-69

5%

9%

2%

3%*

>70

7%

6%

2%

1%

Ethnic or racial group

White

8%

10%

Black

15%

19%

Mexican American

19%

22%

Modified from CDC. Iron deficiency—United States, 1999-2000. MMWR 2002;51:897-879; NCHS. NHANES, 1 nhanes99_00.htm; NCHS. NHANES-III, 1988-1994, 2005. http://www.cdc.gov/nchs/nhanes.htm. ^Unreliable comparison data. fp >0.05 for survey comparisons.

999-2000, 2005. http://www.cdc.gov/nchs/about/major/nhanes/

1988-1994, 1999-2000; NCHS, 2005a, 2005b). The prevalence of iron deficiency is 9% and of iron deficiency anemia 3%, in both genders age 1 to 2 years. The prevalence for children age 3 to 5 years is 3% for iron deficiency and less than 1% for iron deficiency anemia; those 6 to 11 years old have a 2% prevalence of iron deficiency and less than 1% for iron deficiency anemia. The prevalence of iron deficiency in the nonblack population is 1% lower than the prevalence in all races combined. Women have a much higher prevalence; those age 12 to 15 have 9% prevalence of iron deficiency and 2% for iron deficiency anemia; those age 16 to 19 have 11% and 3% prevalence; women 20 to 49 years, 11% and 5%; and those 50 to 69 years, 5% and 2%, respectively. In women over age 70, prevalence of iron deficiency rises to 7% and iron deficiency anemia to 2%. Males in general have less than a 1% prevalence of iron deficiency or iron deficiency anemia until age 50, when the prevalence of iron deficiency rises to 2%. In those older than 70, prevalence of iron deficiency is 4% and iron deficiency anemia 2%.

In a comparative study (Netherlands, Japan, Poland, United States) of diagnostic encounters, blood disorders comprised 1% of all encounters, and iron deficiency was the 27th most frequent diagnosis seen in all four countries (Okkes et al., 2002). Anemia is the most frequent hema-tologic disorder seen in family medicine and occurs often enough that knowledge of RBC function, classification of RBC disorders, evaluation of laboratory data, and treatment of common anemias constitute an important part of the knowledge base of the competent family physician.

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