574 - Structural Inequities in Iron Deficiency Anemia: A case study of three US urban hospitals

Anemia impairs early cognitive & psychomotor development with lifelong consequences. The most common cause of anemia in children is iron deficiency (IDA). US anemia prevalence is 18.1% in children 6-23 months, varying among racial/ethnic groups (Black 22.5%; white 11.2%). Household & child food insecurity (FI) have been associated with anemia. Racial/ethnic health disparities & FI are both rooted in structural inequities, which may impact IDA prevalence.

Objective:

Investigate racial/ethnic & FI differences in IDA diagnosis & treatment.

Design/Methods:

Survey data (2009-2018) from children 6-24 months seen in 3 US urban pediatric centers included sociodemographic characteristics, FI, birthweight (BW), length of gestation, & screen for special health care needs (SHCN). FI was defined using the Household Food Security Survey Module & classified as FI if reported 3+ conditions & child FI if 2+ child-related conditions. Survey data linked with longitudinal electronic health records (EHR) provided lab values of hemoglobin (HGB), median corpuscular value (MCV), lead (Pb), ICD9 & 10, medication. Following national guidelines IDA was defined as Hb≤11.0g/dL & MCV< 77fL.

Results:

Of 1978 children predominantly of color, with HGB+MCV, born at term, BW >2500 grams, no SHCN risk, Pb<10 mcg/dL, & no diseases likely to interfere with lab values, 18.7% had IDA (n=370). Table 1 shows significantly higher prevalence of IDA in children whose mothers self-identified as Hispanic or Black non-Hispanic vs. White non-Hispanic. IDA was also significantly higher in children born to immigrant vs. US-born mothers. A significantly high IDA prevalence was seen in children with household or child FI. Among children with IDA, 36.2% were prescribed iron medication per EHR record (n=134). Of those, 36.6% had a subsequent lab value showing treatment efficacy [n=5 (1.3%)] or inefficacy/undetermined [n=44 (11.9%)]. After adjustment, race/ethnicity, nativity, & FI were not associated with prescription iron medication to treat IDA (Table 2).  

Conclusion(s):

One in five children 6-24 months had IDA. Race/ethnicity & FI differed significantly between children with/without IDA, suggesting structural inequities’ role in IDA development. Only 1.3% of IDA children were adequately treated per EHR over a 6-month period. Racial/ethnic or FI differences were not detected between iron treated/non-treated children potentially due to power limitations. This multi-site case study suggests a need for closer adherence to healthcare guidelines for standard IDA screening & treatment to prevent IDA’s neurocognitive consequences in all children.