HOSPITAL ADMISSIONS FOR IRON DEFICIENCY ANEMIA IN BRAZIL: EPIDEMIOLOGICAL FINDINGS FROM 2019-2020

Abstract

Iron deficiency anemia (IDA) is the most common type of anemia, affecting all ages and being even more prevalent in low- and middle-income countries. Most cases are easily treated at an outpatient clinic and do not need hospitalizations. However, the reasons for hospital admissions for IDA may vary, as it has detrimental effects in patients with coronary artery disease, heart failure, and pulmonary hypertension. Furthermore, IDA is a risk factor for maternal and perinatal mortality, and it is related to low productivity and cognitive impairment. For over 20 years, the Brazilian government has promoted public health politics to prevent IDA, especially in children, and pregnant and postpartum women. This study aims to evaluate the epidemiology of hospitalizations for IDA in Brazil during 2019 and 2020. Cross-sectional, descriptive and retrospective study, which evaluated the epidemiology of hospital admissions for IDA in the Brazilian National Health System in the years 2019 and 2020. Hospital admissions were evaluated by sex, geographic region, and age group using the national database (DATASUS – Department of Informatics of the Unified Health System). During this time period, there was a total of 21523 hospitalizations for iron deficiency anemia in the Brazilian National Health System, with 10981 (51%) hospital admissions in 2019 and 10542 (49%) in 2020. Also, 9079 (42.1%) patients were male and 12444 (57.8%) were female. Most of the hospitalizations occurred in the Southeast region (8767; 40.7%), 5409 (25.1%) in the Northeast region, 3861 (17.9%) in the South region, 1797 (8.4%) in the North region, and 1689 (7.9%) in the Central-West region. Regarding age groups; 562 (2.6%) were less than 1 year old, 862 (4%) were 1-9, 832 (3.9%) were 10-19, 2034 (9.5%) were 20-34, 2463 (11.4%) were 35-44, 4127 (19.2%) were 45-59, 3190 (14.8%) were 60-69, 3607 (16.8%) were 70-79, and 3846 (17.8%) were >80 years old. Considering the population size of the geographic regions, the equal relative number of hospitalizations for IDA among the Brazilian regions may suggest that the impact of social factors on iron deficiency – food insecurity and malnutrition – is a minor problem or at least circumvented by public health preventive strategies, like oral iron supplementation and food fortification. This reflects on the low rates for children and teenagers (<1-19), as their main cause of IDA is low iron intake. There is an increase in the reproductive age (20-44), when it presents even more unfavorable to women due to menstruation and gestation. The elderly (>60) has over three times higher rates than those of children and teenagers, and above the average rate for the reproductive age, marking the relevance of chronic causes and a more equal representation of both sexes. The enforcement of public health preventive strategies appears to be the most contributing factor to the low child and teenager hospitalization rates. However, the overall rates for the adult and elderly population suggest that more effective detection and early intervention are required. Health politics regarding regular gynecologist appointments, better prenatal and postnatal care, and cancer screening can help reducing hospitalization for IDA.