Iron Deficiency Cases Persist Over 3 Years in Statewide Health System

Jacob Cogan, MD

Credit: University of Minnesota

A retrospective study of electronic medical record (EMR) data revealed more than half of people with iron deficiency still experienced low iron levels within 3 years of diagnosis, with younger patients, females, and Black individuals more likely to remain iron deficient.¹

Among individuals whose iron levels were restored to normal in the same period (41.9%), the study demonstrated a median time to iron deficiency resolution of 1.9 years, suggesting notable insufficiencies in treatment delivery.

“Two years is too long and well beyond the timeframe within which iron deficiency should be able to be sufficiently treated and resolved,” said lead author Jacob Cogan, MD, an assistant professor of medicine at the University of Minnesota.² “The numbers are pretty striking and suggest a need to put systems in place to better identify patients and treat them more efficiently.”

Commonly underdiagnosed in high-risk populations, iron deficiency is a frequent harborer of diagnostic challenges, owing to non-specific and underrecognized clinical symptoms, failure to properly interpret laboratory tests, and poor absorption of oral iron supplementation.³ These structural barriers could contribute to a high prevalence of clinically significant iron deficiency that remains undiagnosed or incompletely addressed.

In this study, Cogan and colleagues evaluated EMR data from a large health system in Minnesota, identifying 13,084 individuals with documented iron deficiency between 2010 and 2020.¹ Iron deficiency was defined as a ferritin value ≤25 ng/mL, with a requirement of ≥2 values during a 3-year study period. Resolution of iron deficiency was determined as a subsequent ferritin value of ≥50 ng/mL.

Among the study population, the majority were female, White, had private insurance and received some form of treatment for iron deficiency. Within 3 years of diagnosis, 5485 (42%) patients had normal iron levels, while 7599 (58%) experienced persistent iron deficiency.

The investigative team identified multiple factors linked to a higher likelihood of iron deficiency resolution, including increasing age (≥60 years: adjusted hazard ratio [aHR], 1.56; 95% CI, 1.44 – 1.69; P <.001), male sex (aHR, 1.58; 95% CI, 1.48 – 1.70), and treatment with intravenous iron (aHR, 2.96; 95% CI, 2.66–3.30).

On the other hand, Black patients were less likely to achieve iron deficiency resolution, compared with White patients (aHR, 0.73; 95% CI, 0.66–0.80; P <.001). Those not treated with any iron supplementation also experienced a lower likelihood of resolved iron deficiency (aHR, 0.86; 95% CI, 0.79–0.93; P <.001).

The study was limited by the retrospective use of EMR data, keeping investigators from understanding why ferritin tests were ordered or patients or the cause of iron deficiency.

Overall, Cogan and colleagues indicated the need for clear education about non-anemic iron deficiency and the populations most at risk.² In addition, they called for more universal agreement on the best ferritin cut-off for diagnosis and efforts to create an iron deficiency pathway for treatment.

“Iron deficiency can be challenging to diagnose, but it’s easy to treat,” Cogan added.² “Our findings underscore the need for a more coordinated effort to recognize and treat iron deficiency to help improve quality of life.”

References

1. _{Cogan JC, Meyer J, Jiang Z, Sholzberg M. Iron deficiency resolution and time to resolution in an American health system. Blood Adv. Published online August 15, 2024. doi:10.1182/bloodadvances.2024013197}
2. _{Bloodjournal. Over half of iron deficiency cases in large health system still unresolved at three years. EurekAlert! August 15, 2024. Accessed August 20, 2024. https://www.eurekalert.org/news-releases/1054369.}
3. _{Jefferds MED, Mei Z, Addo Y, et al. Iron Deficiency in the United States: Limitations in Guidelines, Data, and Monitoring of Disparities. Am J Public Health. 2022;112(S8):S826-S835. doi:10.2105/AJPH.2022.306998}