Abstract
Anemia affects 1.62 billion people worldwide. Although iron deficiency is the main cause of anemia, several other factors may explain its high prevalence. In this study, we sought to analyze the association between outdoor particulate matter PM2.5 levels with anemia prevalence in children aged 6–59 months residing in Lima, Peru (n = 139,368), one of the cities with the worst air pollution in Latin America. The study period was from 2012 to 2016. Anemia was defined according to the World Health Organization (Hb < 11 g/dL). PM2.5 values were estimated by a mathematical model that combined data observed from monitors, with satellite and meteorological data. PM2.5 was analyzed by quintiles. Multiple linear and logistic regressions were used to estimate the associations between hemoglobin concentration (beta) and anemia (odds ratio) with PM2.5, after adjusting by covariates. Prevalence of anemia was 39.6% (95% confidence interval (CI): 39.3–39.9). Mild anemia was observed in 30.8% of children and moderate/severe in 8.84% of children. Anemic children compared with nonanemic children are mainly males, have low body weight, higher rate of stunting, and live in an environment with high PM2.5 concentration. A slight decrease in hemoglobin (4Q B: −0.03, 95% CI: −0.05 to −0.02; 5Q B: −0.04, 95% CI: −0.06 to −0.01) and an increase in the probability of moderate/severe anemia (4Q OR: 1.18, 95% CI: 1.10–1.27; 5Q OR: 1.18, 95% CI: 1.08–1.29) were observed with increased exposure to PM2.5. We conclude that outdoor PM2.5 levels were significantly associated with decreased hemoglobin values and an increase in prevalence of moderate/severe anemia in children under 5 years old.
Highlights
Anemia affects 1.62 billion people worldwide [1] and is associated with numerous adverse health outcomes, including increased mortality and cognitive disorders
According to the World Health Organization (WHO), 50% of cases of anemia are due to iron deficiency, while 42% of the cases are of inflammatory origin
Mild anemia was observed in 30% of the population, while severe/moderate anemia was observed in 8.8% of the population
Summary
Anemia affects 1.62 billion people worldwide [1] and is associated with numerous adverse health outcomes, including increased mortality and cognitive disorders. Developing countries account for 89% of all anemia-related disability [2]. According to the WHO, 50% of cases of anemia are due to iron deficiency, while 42% of the cases are of inflammatory origin (inflammatory anemia). Inflammatory anemia or anemia of inflammation (AI) in children aged 6–59 months is mainly related to infectious diseases in less developed countries [3]. Infections are not the only cause for inflammation. Evidence suggests that chronic diseases such as chronic kidney disease, congestive heart failure, chronic pulmonary disease, and obesity may result in AI [4, 5]
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