(P03-043-24) Exploring Inequities in Iron Deficiency Anemia: A Case Study of Three US Urban Hospitals

Objectives: Anemia impairs early cognitive & psychomotor development with lifelong consequences. The most common anemia is iron deficiency (IDA). US anemia prevalence is 18.1% in children 6-23 months, varying among racial/ethnic groups (Black 22.5%; white 11.2%). Household & child food insecurity (FI) have been associated with anemia. Racial/ethnic health disparities & FI are both rooted in structural inequities, which may impact IDA prevalence. Thus, we aimed to investigate racial/ethnic & FI differences in IDA diagnosis & treatment.

Methods: Survey data (2009-2018) from children 6-24 months seen in 3 US pediatric centers included sociodemographic characteristics, FI, birthweight (BW), length of gestation, & screen for special health care needs (SHCN). FI was defined using the Household Food Security Survey Module & households classified as FI (3+ conditions) & child FI (2+ child-related conditions). Survey data linked with longitudinal electronic health records (EHR) provided lab values of hemoglobin (Hgb), median corpuscular value (MCV), lead (Pb), ICD9 & 10, medication. Following national guidelines IDA was defined as Hgb≤11.0g/dL & MCV < 77fL.

Results: Of 1978 children with HGB+MCV, born at term, BW >2500 grams, no SHCN risk, Pb <10 mcg/dL, & no diseases likely to interfere with lab values, 18.7% had IDA (n=370). Among those, 36.2% were prescribed iron medication per EHR record (n=134). Of those, 36.6% (n=5) had a subsequent lab value showing treatment efficacy, the equivalent of 1.3% of initial IDA sample. Significantly higher prevalence of IDA was found in children born to Hispanic or Black non-Hispanic mothers (vs. White non-Hispanic, Other), immigrant mothers (vs. US-born), living with household FI or child FI. After adjustment, race/ethnicity, nativity, & FI were not associated with iron medication prescription to treat IDA.

Conclusions: One in five children 6-24 months had IDA and only 1.3% were adequately treated. Race/ethnicity & FI differed significantly between children with/without IDA, suggesting structural inequities’ role in IDA development. These differences were not detected in iron treated/non-treated children. This multi-site case study suggests a need for closer adherence to healthcare guidelines for standard IDA screening & treatment to prevent IDA’s neurocognitive consequences in all children.

Funding Sources: N/A