Contextualising the High Prevalence of Anaemia in the Portuguese Population: Perception, Characterisation and Predictors: an EMPIRE Sub-Study
DOI:
https://doi.org/10.24950/rspmi.838Keywords:
Portugal, Anemia/therapy, Anemia, Iron-Deficiency, Folic Acid, Iron/deficiency, Prevalence, Risk Factors, Vitamin B12Abstract
Introduction: Anaemia is a public health issue with negative
impact on quality of life. We aim to evaluate the
perception of anaemia diagnosis in the Portuguese population,
as well as evaluate the characteristics and predictors
of anaemia.
Materials and Methods: Cross-sectional, epidemiological
study comprising a sample of 7890 adults representative
of the Portuguese population. Participants were inquired
about their demographic, anthropometric and clinical
characteristics, and their perception about the diagnosis
of anaemia; serum levels of haemoglobin, ferritin, creatinine
and C-reactive protein were measured using point-ofcare
devices. Anaemia was classified according to the
criteria of the World Health Organization.
Results: Although the prevalence on anaemia in Portugal
is estimated at 20.6%, only 10.2% of participants referred
having had a diagnosis of anaemia. The perception
of anaemia was higher within the region of Lisbon and
Tagus Valley (20.6%). Nutritional deficiency anaemia
(57.7%), especially iron deficiency anaemia (52.7%), represented
most known diagnosed cases. Only 52.6% of
participants that have had the diagnosis of anaemia reported
being treated; among those, iron supplementation
was the most common treatment. At the time of the study
only 0.8% of participants with “measured” anaemia was
on specific treatment. The following predictors of anaemia
were identified: female gender, age ≥ 80 years, vegetarian
diet, student as professional situation, treatment with
anticoagulants and gastric protectors, renal failure, and
iron deficiency.
Discussion and Conclusions: Although anaemia affects
approximately one in five Portuguese residents, the perception
of the disease is alarmingly low, suggesting a
high rate of undiagnosed/untreated cases. Strategies to
improve awareness of this condition should be urgently developed, especially in high-risk groups.
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References
World Health Organization. Worldwide prevalence of anemia 1993-2005. WHO Global Database on Anaemia. Geneva: WHO; 2008.
World Health Organization. Assessing the Iron Status of populations. Geneva: WHO; 2007.
Balarajan Y, Ramakrishnan U, Ozaltin E, Shankar AH, Subramanian SV. Anaemia in low-income and middle-income countries. Lancet.
;378:2123–35.
Carmel R. Nutritional anemias and the elderly. Semin Hematol. 2008;45:225–34.
Steinberg MH. Genetic etiologies for phenotypic diversity in sickle cell anemia. Sci World J. 2009;9:46–67.
Davis SL, Littlewood TJ. The investigation and treatment of secondary anaemia. Blood Rev. 2012;26:65–71.
Weiss G, Goodnough LT. Anemia of chronic disease. N Engl J Med. 2005;352:1011–23.
Kalaivani K. Prevalence & consequences of anaemia in pregnancy. Indian J Med Res. 2009;130:627–33.
Bentley ME, Griffiths PL. The burden of anemia among women in India. Eur J Clin Nutr. 2003;57:52–60.
Monarrez-Espino J, Martinez H, Greiner T. Iron deficiency anemia in Tarahumara women of reproductive-age in northern Mexico. Salud Publica Mex. 2001;43:392–401.
Singh K, Fong YF, Arulkumaran S. Anaemia in pregnancy--a cross-sectional study in Singapore. Eur J Clin Nutr. 1998;52:65–70.
Friedman AJ, Chen Z, Ford P, Johnson CA, Lopez AM, Shander A, et al. Iron deficiency anemia in women across the life span. J Womens Health. 2012;21:1282–9.
Coad J, Pedley K. Iron deficiency and iron deficiency anemia in women. Scand J Clin Lab Invest Suppl. 2014;244:82–9; discussion 89.
World Health Organization. Iron deficiency anaemia: assessment, prevention and control. A guide for programme managers. Geneva: WHO; 2001.
Marx JJ. Iron deficiency in developed countries: prevalence, influence of lifestyle factors and hazards of prevention. Eur J Clin Nutr. 1997;51:491–4.
Tolentino K, Friedman JF. An update on anemia in less developed countries. Am J Trop Med Hyg. 2007;77:44–51.
Aspuru K, Villa C, Bermejo F, Herrero P, Lopez SG. Optimal management of iron deficiency anemia due to poor dietary intake. Int J Gen Med. 2011;4:741–50.
Bungiro R, Cappello M. Twenty-first century progress toward the global control of human hookworm infection. Curr Infect Dis Rep. 2011;13:210–7.
Johnson-Wimbley TD, Graham DY. Diagnosis and management of iron deficiency anemia in the 21st century. Ther Adv Gastroenterol.
;4:177–84.
Hercberg S, Preziosi P, Galan P. Iron deficiency in Europe. Public Health Nutr. 2001;4:537–45.
Fonseca C, Marques F, Robalo Nunes A, Belo A, Brilhante D, Cortez J. Prevalence of anaemia and iron deficiency in Portugal: the EMPIRE study. Intern Med J. 2016;46:470–8.
Hoffmeyer-Zlotnik JH. New Sampling Designs and the Quality of Data. Dev Appl Stat. 2003;19:205–17.
Sullivan KM, Dean A, Soe MM. OpenEpi: a web-based epidemiologic and statistical calculator for public health. Public Health Rep 2009;124:471–4.
Stauder R, Thein SL. Anemia in the elderly: Clinical implications and new therapeutic concepts. Haematologica. 2014;99:1127–30.
Dwyer JT. Nutritional consequences of vegetarianism. Annu Rev Nutr. 1991;11:61–91.
Obeid R, Geisel J, Schorr H, Hubner U, Herrmann W. The impact of vegetarianism on some haematological parameters. Eur J Haematol.
/12/04. 2002;69(5–6):275–9.
Kulnigg S, Gasche C. Systematic review: managing anaemia in Crohn’s disease. Aliment Pharmacol Ther. 2006;241507–23.
Shah R, Agarwal AK. Anemia associated with chronic heart failure: current concepts. Clin Interv Aging. 2013;8:111–22.
~
Lankhorst CE, Wish JB. Anemia in renal disease: diagnosis and management. Blood Rev. 2010;24:39–47.
Wittwer I. Iron deficiency anaemia in chronic kidney disease. J Ren Care. 2013;39:182–8.
Aapro M, Österborg A, Gascón P, Ludwig H, Beguin Y. Prevalence and management of cancer-related anaemia, iron deficiency and the specific role of i.v. iron. Ann Oncol. 2012;23:1954–62.
Gilreath JA, Stenehjem DD, Rodgers GM. Diagnosis and treatment of cancer-related anemia. Am J Hematol. 2014;89:203–12.
Gafter-Gvili A, Rozen-Zvi B, Vidal L, Leibovici L, Vansteenkiste J, GafterU, et al. Intravenous iron supplementation for the treatment of chemotherapy-induced anaemia - systematic review and meta-analysis of randomised controlled trials. Acta Oncol. 2013;52:18–29.
Bormanis J, Quirt I, Chang J, Kouroukis CT, MacDonald D, Melosky B, et al. Erythropoiesis-stimulating agents (ESAs): do they still have a
role in chemotherapy-induced anemia (CIA)? Crit Rev Oncol Hematol.2013;87:132–9.
Groopman JE, Itri LM. Chemotherapy-induced anemia in adults: incidence and treatment. J Natl Cancer Inst. 1999;91:1616–34.
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