Iron deficiency mortality
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Iron Deficiency Prevalence and Global Mortality Impact
Iron deficiency is one of the most common nutritional disorders worldwide and is a significant contributor to mortality and disability, especially in low- and middle-income regions. Globally, iron deficiency is estimated to account for over 841,000 deaths and more than 35 million disability-adjusted life years lost, with the highest burden seen in Africa and parts of Asia. Iron deficiency contributes to death both directly, through severe anemia, and indirectly, as a risk factor for maternal and perinatal mortality, as well as cognitive impairment and reduced work productivity .
Iron Deficiency and All-Cause Mortality in the General Population
Large population studies have shown that iron deficiency is highly prevalent even among apparently healthy adults. In a cohort study, over half of participants had functional iron deficiency, and this condition was independently associated with increased all-cause mortality over a 10-year follow-up. The risk of death was higher for those with absolute iron deficiency compared to those with functional iron deficiency, even after adjusting for hemoglobin levels and cardiovascular risk factors .
Iron Deficiency Anemia-Related Mortality Trends in the United States
In the United States, iron deficiency anemia-related mortality rates have increased in recent years, particularly among older adults. From 2013 to 2019, there was a sharp rise in mortality rates, with no significant differences by sex, race, ethnicity, or urbanicity. This trend parallels a decline in dietary iron intake, attributed to changes in food iron content and dietary patterns, such as reduced beef consumption and increased chicken intake. These dietary shifts have contributed to a rise in iron deficiency anemia and related deaths 37.
Iron Deficiency and Mortality in Specific Patient Populations
Chronic Heart Failure
Iron deficiency is common in patients with chronic heart failure and is a strong, independent predictor of mortality, even more so than anemia itself. Patients with iron deficiency have worse outcomes and higher risk of death, regardless of their anemia status . However, meta-analyses of randomized controlled trials have not shown that iron supplementation reduces all-cause mortality in heart failure patients with iron deficiency .
Cardiac Surgery
Among patients undergoing cardiac surgery, preoperative iron deficiency is associated with increased 90-day mortality, more serious adverse events, and longer hospital stays. This risk is present both in patients with and without anemia, highlighting the importance of screening for iron deficiency before surgery .
Myocardial Infarction
Iron deficiency is also common in patients after myocardial infarction (MI) and is linked to higher all-cause mortality. The combination of low iron and elevated soluble transferrin receptor levels provides the best prediction of mortality risk. Some evidence suggests that iron therapy may reduce short-term mortality in MI patients with iron deficiency, but further research is needed 610.
Leukemia
Interestingly, in patients with leukemia, iron deficiency anemia was not associated with increased inpatient mortality. In some subgroups, such as those with chronic lymphocytic leukemia, iron deficiency anemia was linked to lower odds of death, though the reasons for this are not yet clear and require further investigation .
Conclusion
Iron deficiency is a widespread health problem that independently increases the risk of mortality in the general population and in several high-risk groups, such as those with heart failure, after cardiac surgery, and following myocardial infarction. Recent trends show rising iron deficiency anemia-related mortality, particularly in older adults in the United States, likely due to dietary changes. While iron supplementation has not consistently reduced mortality in all patient groups, targeted interventions and routine screening for iron deficiency remain important for reducing its health impact.
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