What was the prevalence of anemia during August 2021–August 2023, and were differences observed by age and sex?

In August 2021–August 2023, the prevalence of anemia was 9.3% in those age 2 years and older (Figure 1, Table 1). The prevalence was higher in females (13.0%) than in males (5.5%) overall, and for some age groups. The prevalence of anemia in females ages 12–19 years (17.4%) and 20–59 (14.0%) was higher than in males in the same age groups (0.9% and 3.9%, respectively). The prevalence of anemia in children ages 2–11 and adults 60 and older did not differ by sex.

Figure 1

Prevalence of anemia in people age 2 years and older, by age group and sex: United States, August 2021–August 2023. ¹Significantly different from female. ²Significantly different from ages 12–19 years

Data table for Figure 1

Prevalence of anemia in people age 2 years and older, by age group and sex: United States, August 2021–August 2023.

The prevalence of anemia was lower in children ages 2–11 (4.7%) than in any other age group. The prevalence of anemia was also lower in adolescents ages 12–19 and in adults 20–59 (9.0% each) than in adults 60 and older (12.5%). In males, the prevalence of anemia was lower in ages 2–11 (3.9%, although this estimate did not meet statistical reliability criteria), adolescents 12–19 (0.9%), and adults 20–59 (3.9%) than in men 60 and older (12.8%). In females, the pattern was different: The prevalence of anemia was lower in ages 2–11 (5.7%) compared with all other age groups, and higher in adolescents ages 12–19 (17.4%) than in women 60 and older (12.4%).

Did the prevalence of anemia differ by race and Hispanic origin and sex?

The prevalence of anemia was higher in Black non-Hispanic (subsequently, Black) people (22.0%) compared with Asian non-Hispanic (subsequently, Asian) (11.8%), Hispanic (10.9%), and White non-Hispanic (subsequently, White) (6.1%) people (Figure 2, Table 2). Prevalence was also higher in Asian and Hispanic people compared with White people. The prevalence of anemia was higher in females than males among all race and Hispanic-origin groups.

Figure 2

Prevalence of anemia in people age 2 years and older, by race and Hispanic origin and sex: United States, August 2021–August 2023. ¹Significantly different from Black non-Hispanic. ²Significantly different from White non-Hispanic.

Data table for Figure 2

Prevalence of anemia in people age 2 years and older, by race and Hispanic origin and sex: United States, August 2021–August 2023.

Among males, the prevalence of anemia was highest in Black males (10.8%) compared with Hispanic (7.1%), Asian (7.0%), and White (3.9%) males.

Among females, the prevalence of anemia in Black females (31.4%) was highest compared with Asian (15.9%), Hispanic (15.0%), and White (8.3%) females. The prevalence of anemia also was higher in Asian and Hispanic females compared with White females.

Did anemia prevalence vary by family income and sex?

The prevalence of anemia decreased with increasing income, from 14.1% in people whose family income was less than 130% of the poverty level to 9.8% in people with family income 130%–349% of the poverty level and 5.7% in those with family income 350% or more of the poverty level (Figure 3, Table 3).

Figure 3

Prevalence of anemia in people age 2 years and older, by family income and sex: United States, August 2021–August 2023. ¹Significant linear trend by family income. ²Significantly different from female.

Data table for Figure 3

Prevalence of anemia in people age 2 years and older, by family income and sex: United States, August 2021–August 2023.

The trend of lower anemia with increasing income was observed for both males and females. Males and females age 2 years and older at the highest poverty level had more than double the anemia prevalence (males, 8.7%; females, 18.7%) compared with those at the lowest poverty level (males, 3.5%; females, 8.1%). Anemia prevalence was higher in females than males for all income groups.

Summary

During August 2021–August 2023, the prevalence of anemia was 9.3% in the U.S. population age 2 years and older. Males had a lower prevalence of anemia than females in all race and Hispanic-origin groups; this was also true in all income groups, but not in all age groups.

Clear trends were seen in anemia prevalence by income group. Males and females age 2 and older in the lowest income group had more than double the prevalence of anemia compared with males and females in the highest income group. Differences by race and Hispanic origin also were found, with Black people having the highest prevalence of anemia compared with all other race and Hispanic-origin groups.

Reducing anemia prevalence is a global goal (5). In 2012, the World Health Assembly (the health policy body of the World Health Organization) set a target to reduce anemia prevalence in women of reproductive age by 50% by 2025 (5). Like most countries, the United States is not on track to meet that goal (6). In females ages 15–49, anemia prevalence increased from 7.8% in 2000 to 11.5% in 2018 (7), and during August 2021–August 2023, the prevalence of anemia was 17.4% for adolescent girls 12–19 and 14.0% for women 20–59.

Definitions

Anemia: Hemoglobin (Hb) less than 11.0 g/dL for children ages 2–4; Hb less than 11.5 g/dL for children 5–11; Hb less than 12.0 g/dL for children 12–14 and females 15 and older; and Hb less than 13.0 g/dL for males 15 and older (8). Hb concentration was not adjusted for the effects of altitude, but it was adjusted for smoking following World Health Organization guidance (8).

Poverty level: Annual total family income divided by the dollar amount defined by the U.S. Department of Health and Human Services poverty guidelines to account for inflation and family size (9).

Data source and methods

Data from NHANES for August 2021–August 2023 were used to estimate anemia prevalence, with measured Hb and published cutoffs based on age and sex (8).

NHANES is a cross-sectional survey designed to monitor the health and nutritional status of the U.S. civilian noninstitutionalized population. The NHANES sample is selected through a complex, multistage probability design. NHANES is conducted by the National Center for Health Statistics (10) and consists of home interviews followed by standardized health examinations conducted in mobile examination centers, where venous blood is collected for a variety of measurements including Hb. Hb is measured for NHANES participants age 1 year and older as part of a complete blood count laboratory test using a Beckman Coulter DxH 800 instrument.

This report is based on analyses that included all examined NHANES participants age 2 years and older. Pregnant women and anyone with missing Hb concentration were excluded. Phlebotomy sample weights were used to calculate nationally representative estimates. These weights—provided for the first time with the August 2021–August 2023 public file release for use with phlebotomy-related variables—account for the differential probabilities of selection and nonresponse, including nonresponse to venous blood collection. All analyses accounted for the survey’s complex, multistage probability design. For August 2021–August 2023, differences between estimates overall and among subgroups were evaluated using t tests at the 0.05 level. Linear regression was used to test the significance of a linear trend by income.

Data management and statistical analyses were conducted using SAS System for Windows version 9.4 (SAS Institute, Inc., Cary, N.C.) and SUDAAN version 11.0.4 (RTI International, Research Triangle Park, N.C.).

About the authors

Anne M. Williams, Nicholas Ansai, Namanjeet Ahluwalia, and Duong T. Nguyen are with the National Center for Health Statistics, Division of Health and Nutrition Examination Surveys.

References

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Brittenham GM, Moir-Meyer G, Abuga KM, Datta-Mitra A, Cerami C, Green R, et al. Biology of anemia: A public health perspective. J Nutr 153 Suppl 1:S7–S28. 2023. [PubMed: 37778889]

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Daru J, Zamora J, Fernández-Félix BM, Vogel J, Oladapo OT, Morisaki N, et al. Risk of maternal mortality in women with severe anaemia during pregnancy and post partum: A multilevel analysis. Lancet Glob Health 6(5):e548–e54. 2018. [PubMed: 29571592]

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World Health Organization. Global nutrition targets 2025: Policy brief series. 2014.

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Stevens GA, Paciorek CJ, Flores-Urrutia MC, Borghi E, Namaste S, Wirth JP, et al. National, regional, and global estimates of anaemia by severity in women and children for 2000–19: A pooled analysis of population-representative data. Lancet Glob Health 10(5):e627–e39. 2022.

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World Health Organization. The Global Health Observatory: SDG target 2.2 malnutrition. Available from: https://www​.who.int/data​/gho/data/themes​/topics/sdg-target-2_2-malnutrition.

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World Health Organization. Guideline on haemoglobin cutoffs to define anaemia in individuals and populations. 2024.

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U.S. Department of Health and Human Services, Assistant Secretary of Planning and Evaluation. 2021 poverty guidelines. Available from: https://aspe​.hhs.gov​/2021-poverty-guidelines.

10.

Terry AL, Chiappa MM, McAllister J, Woodwell DA, Graber JE. Plan and operations of the National Health and Nutrition Examination Survey, August 2021–August 2023. National Center for Health Statistics. Vital Health Stat 1(66). 2024. DOI: 10.15620/cdc/151927. [CrossRef]

National Center for Health Statistics

Brian C. Moyer, Ph.D., Director

Amy M. Branum, Ph.D., Associate Director for Science

Division of Health and Nutrition Examination Surveys

Alan E. Simon, M.D., Director

Lara J. Akinbami, M.D., Associate Director for Science

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ISSN 1941–4927 Print ed.

ISSN 1941–4935 Online ed.

Williams AM, Ansai N, Ahluwalia N, Nguyen DT. Anemia prevalence: United States, August 2021–August 2023. NCHS Data Brief, no 519. Hyattsville, MD: National Center for Health Statistics. 2024. DOI: https://dx.doi.org/10.15620/cdc/168890. [PMC free article]