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Gender differences in determinants of iron-deficiency anemia: a population-based study conducted in four European countries

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Abstract

Iron-deficiency anemia (IDA) was the main condition contributing to higher rates of years lived with disabilities in women in 2016. To date, few studies have investigated gender differences in determinants of IDA in Europe. The aim of the present study was to evaluate the determinants of IDA among females and males in four European countries. IDA determinants were estimated using multivariable Cox regression based on information gathered from national primary care databases, namely Italy (for years 2002–2013), Belgium, Germany, and Spain (for years 2007–2012). Adjusted hazard ratios (aHR) with 95% confidence intervals (CIs) were estimated. Age was significantly associated with IDA in females of childbearing age in all four countries, as well as pregnancy, for which the aHR ranged from 1.20 (95% CI 1.15–1.25) in Italy to 1.88 (95% CI 1.53–2.31) in Germany. In males, the aHR increased with age starting from the 65–69 age group. Menometrorrhagia was associated with IDA in Germany (aHR 2.71, 95% CI 1.96–3.73), Italy (aHR 1.80, 95% CI 1.60–2.03), and Spain (aHR 1.52, 95% CI 1.31–1.76). A greater risk for women with alopecia was also observed. Weakness and headache indicated a higher risk in both men and women. Patients with diseases characterized by blood loss or gastrointestinal malabsorption were also at significantly increased risk. Physicians should encourage women of childbearing age to adhere to dietary recommendations regarding iron intake and regularly prescribe screening of iron status. Upper and lower gastrointestinal investigations should be recommended for patients with a confirmed diagnosis of IDA.

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Funding

This study was supported by Pierre Fabre, which had no role in designing, performing, and writing the study. The content is solely the responsibility of the authors and does not represent the views of the funding institution.

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Correspondence to Francesco Lapi.

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F. Lapi provided consultancies in protocol preparation for epidemiological studies and data analyses for Pierre Fabre.

A. Masotti is a scientific consultant and/or an Advisory Board member for Anemia Alliance. V. Pegoraro and F. Heiman are employed at IQVIA Italy.

O. Brignoli, M. Cancian, C. Cricelli provided clinical consultancies for Pierre Fabre. M. Levi, M. Simonetti and E. Marconi have no conflict of interest to disclose.

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This was a retrospective observational study, for which the approval by the Ethics Committee is not required (GU n. 76 March 31, 2008). All procedures performed in studies involving human participants were in accordance with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Levi, M., Simonetti, M., Marconi, E. et al. Gender differences in determinants of iron-deficiency anemia: a population-based study conducted in four European countries. Ann Hematol 98, 1573–1582 (2019). https://doi.org/10.1007/s00277-019-03707-w

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