Iron Deficiency and Iron-Deficiency Anemia Among Reproductive-Age Women in the United States: Prevalence and Disparities, 2015-2023.

INTRODUCTION

Iron deficiency (ID) and iron-deficiency anemia (IDA) remain highly prevalent among U.S. reproductive-age women, with substantial racial, ethnic, and socioeconomic disparities. This study examined the contemporary burden of ID and IDA among U.S. reproductive-age women using inflammation-adjusted diagnostic criteria and an explicit health equity framework.

METHODS

Cross-sectional analysis of 3322 women aged 18-49 years from the National Health and Nutrition Examination Survey (2015-2023). ID and IDA were defined using World Health Organization 2020 inflammation-adjusted ferritin thresholds incorporating C-reactive protein. Multivariable logistic regression examined associations between sociodemographic factors and iron status outcomes.

RESULTS

Among nonpregnant women (n = 3156), 27.4% had ID and 8% had IDA. Among pregnant women (n = 166), 75.5% had ID and 8.3% had IDA. Non-Hispanic Black women had 2.8-fold higher odds of IDA (adjusted odds ratio [aOR] 2.8, 95% CI 1.6, 4.9). Obesity was independently associated with ID (aOR 2.4, 95% CI 1.86, 3.24) in nonpregnant women and pregnant women (aOR 4.5, 95% CI 1.08, 18.76). Racial and ethnic disparities persisted after adjustment for education, income, and food security.

CONCLUSIONS

ID and IDA remain highly prevalent among U.S. reproductive-age women, with substantial and persistent racial, ethnic, and socioeconomic disparities. As a preventable and treatable condition with significant impacts on quality of life and pregnancy outcomes, it warrants greater clinical and public health attention, particularly among non-Hispanic Black women, Hispanic women, women with obesity, and those experiencing socioeconomic disadvantages.