Burden and causes of anemia in Vietnam: insights from the global burden of disease data | BMC Public Health

Burden and causes of anemia in Vietnam: insights from the global burden of disease data | BMC Public Health

Prevalence of total anemia cases and severity level

Online Supplementary Table 2 presents total anemia cases across all ages in Vietnam between 1990 and 2021, and reveals both progress and persistent challenges. In 1990, the total number of anemia cases was 16.30 million, which decreased slightly to 16.05 million in 2021. This represents a modest reduction of 0.25 million cases, or approximately 1.5%. When breaking down the data by gender, a clear divergence in trends emerges. In 1990, there were 5.69 million anemia cases among males and 10.61 million among females. By 2021, anemia prevalence among males had dropped to 4.27 million, a significant 25% reduction. In contrast, anemia cases among females increased by 11%, from 10.61 million in 1990 to 11.78 million in 2021. The slight overall reduction in anemia prevalence masks notable shifts in the age distribution of cases. While anemia has decreased significantly among infants, young children, and adolescents, reflecting improvements in maternal and child healthcare, the burden has shifted toward middle-aged and older adults. Anemia cases among middle-aged adults and older people have surged, particularly among females. This rising trend among older populations may be driven by factors such as aging-related health conditions, chronic diseases, and inadequate attention to nutrition and healthcare for these groups.

Figure 1 illustrates the prevalence of anemia cases categorized by severity (mild, moderate, and severe) across all age groups and both sexes in Vietnam from 1990 to 2021. The data indicates a notable shift in the distribution of anemia severity over the period. In 2021, mild anemia accounted for 58% of total anemia cases, marking an increase from 53% in 1990. Conversely, moderate anemia constituted 38% of cases in 2021, down from 42% in 1990. Severe anemia remained relatively low throughout the period, comprising only 4% of cases.

Fig. 1
figure 1

Percentage distribution of anemia cases in Vietnam by severity for all ages and male and female sexes, 1990–2021

Source: Author’s computation from GBD Study-2021

Prevalence of total anemia cases by age and sex

Figure 2 presents anemia prevalence across different age groups, highlighting the distribution of cases by sex for the years 1990 and 2021. Key patterns emerge when comparing these two periods, reflecting shifts in anemia prevalence between males and females in Vietnam over the 30-year span. Across all age groups, male anemia prevalence has decreased from 34.90% in 1990 to 26.58% in 2021. For females, the opposite trend is observed. Female anemia prevalence has increased from 65.10% in 1990 to 73.42% in 2021.

The results show that gender differences in anemia prevalence across all age groups persist in Vietnam. Females in every age group from early childhood to older adults show higher anemia prevalence in 2021 compared to 1990, whereas males show either a decrease or a stable trend. The rising prevalence among females could be due to factors such as reproductive health challenges, societal inequalities, and access to healthcare and nutrition [28, 29]. The persistent gender gap in anemia prevalence points to potential socio-economic factors that disadvantage females. Addressing these root causes, such as poverty, access to healthcare, and nutritional education, could help reduce the anemia burden among women.

Fig. 2
figure 2

Percentage distribution of anemia prevalence cases in Vietnam by sex for all age groups, 1990–2021

Note: Percentage is calculated from the total anemia prevalence cases. Anemia prevalence cases of age categories and sex is reported in Supplementary Table 1

Source: Author’s computation from GBD Study-2021

Causes of anemia prevalence cases

Table 1 outlines the prevalence of anemia cases by cause in Vietnam in 1990 and 2021. It reveals significant trends in the underlying factors contributing to anemia and the effectiveness of public health interventions over time. Iron deficiency remains the dominant cause of anemia across both years, accounting for 68.35% of cases in 1990 and 68.84% in 2021. However, the total number of iron deficiency cases decreased slightly from 11.14 million in 1990 to 11.05 million in 2021. Other Hemoglobinopathies showed a dramatic increase, rising from 0.94 million (5.78%) in 1990 to 1.07 million (6.70%) in 2021, moving from the third- to the second-most prevalent cause of anemia. Beta-thalassemia trait prevalence also slightly increased from 0.86 million to 0.89 million, maintaining a high rank (third in 2021). Other infectious diseases contributing to anemia decreased slightly from 0.79 million (4.83%) in 1990 to 0.74 million (4.64%) in 2021, maintaining its fifth rank.

Hookworm disease, a historically significant cause of anemia, saw a dramatic reduction, dropping from 0.32 million cases in 1990 to just 12,792 cases in 2021, falling from the 6th to the 20th rank. This significant decline highlights the success of deworming programs and improved sanitation in reducing parasitic infections that contribute to anemia [30, 31]. Vitamin A deficiency as a cause of anemia decreased from 0.27 million (1.65%) in 1990 to 66,637 cases (0.42%) in 2021, reflecting improved nutritional interventions and fortification programs that have likely helped reduce the prevalence of vitamin deficiencies. PfPr malaria, a previously significant contributor to anemia, was effectively eliminated as a cause by 2021, demonstrating the success of malaria eradication efforts in Vietnam. Chronic kidney disease (CKD), particularly at stage 3, increased as a cause of anemia, rising from 192,113 cases (1.18%) in 1990 to 327,856 cases (2.04%) in 2021. This reflects a growing burden of chronic diseases as the population ages and highlights the need for targeted healthcare interventions to manage anemia in patients with CKD. HIV/AIDS emerged as a notable cause of anemia, with cases rising from 2,084 in 1990 to 18,062 in 2021. This increase underscores the need for continued focus on HIV/AIDS management, particularly its impact on anemia. Anemia related to gastritis and duodenitis, as well as higher-stage CKD, also saw increases in 2021, reflecting ongoing challenges associated with chronic gastrointestinal and renal conditions. Some causes, such as schistosomiasis and hemoglobin SC disease, showed negligible or zero prevalence by 2021, indicating successful healthcare interventions and eradication efforts. Additionally, clinical malaria saw a near elimination by 2021, another testament to successful disease control programs in the country.

Table 1 Ranking of number and percent distribution of anemia cases by cause in Vietnam in 1990 and 2021

Causes of anemia prevalence cases by sex and age in Vietnam

Figure 3 presents the percentage distribution of anemia cases by cause and sex (male and female) in Vietnam for 2021. Iron deficiency was a significant cause of anemia in 2021, affecting 24.96% of males and 75.04% of females. This indicates that iron deficiency remains a major health issue, particularly for females. HIV/AIDS was another leading cause, accounting for 69.79% of anemia cases in males and 30.21% in females, reflecting the ongoing impact of this disease despite improvements in treatment. Mild sickle cell/beta-thalassemia was the highest cause of anemic females, with a prevalence of 75.36%, compared to 24.64% in males. This highlights a persistent burden of genetic blood disorders among females. Additionally, hookworm disease affected 38.31% of males and 61.69% of females, suggesting it remains a significant health issue. Online Supplementary Fig. 1 presents the percentage of anemia prevalence cases in 1990 by cause and sex in Vietnam. In 1990, HIV/AIDS was the leading cause of anemia in males (76.45%), which decreased to 69.79% in 2021, reflecting improvements in managing the disease. The prevalence of iron deficiency anemia in females increased from 66.13% in 1990 to 75.04% in 2021, indicating a growing concern. The prevalence of Mild Sickle Cell/Beta-Thalassemia in females significantly increased from 26.19% in 1990 to 75.36% in 2021, highlighting the persistent and growing burden of genetic blood disorders.

Fig. 3
figure 3

Percentage of anemia prevalence cases by cause between males and females in Vietnam, 2021

Source: Author’s computation from GBD Data-2021

Note: Percentage of male and female prevalence by cause is calculated from the total prevalence for specific causes. Specific causes number is presented in Table 1

Fig. 4
figure 4

Percentage distribution of anemia prevalence cases by cause and age in Vietnam, 2021

Source: Author’s computation from GBD data-2021

Note: The percentage distribution of specific age-wise causes is calculated from the total age prevalence of specific causes. Specific causes number is presented in Table 1

Figure 4 and Online Supplementary Fig. 2 provide a comparison of the percentage distribution of anemia prevalence by cause and age group in Vietnam for 2021 and 1990. The leading causes of anemia in Vietnam vary significantly across different age groups in 2021. Among infants (0–23 months), Vitamin A deficiency was the leading cause, accounting for 30.51% of anemia cases, followed by other NTDs (Neglected Tropical Diseases) at 11.68% and iron deficiency at 7.58%. These figures suggest that nutritional deficiencies remain a significant contributor to anemia in the youngest population. In early childhood (2–9 years), Vitamin A deficiency continued to dominate, responsible for 59.97% of anemia cases, with hookworm disease (25.61%) and other NTDs (19.99%) following closely behind. This demonstrates that parasitic infections and nutrient deficiencies are critical concerns during this developmental phase.

Among adolescents (10–19 years), the prevalence of anemia shifted, with iron deficiency accounting for 10.28% and beta-thalassemia trait making up 10.39%, highlighting the growing influence of genetic hemoglobinopathies alongside nutritional factors. As the population enters young adulthood (20–39 years), the leading causes become iron deficiency at 28.45% and beta-thalassemia trait at 25.60%, indicating a shift towards genetic factors as the primary drivers of anemia. Notably, in middle-aged adults (40–64 years), iron deficiency (28.44%) and beta-thalassemia trait (29.46%) remained the predominant causes, showing continuity from young adulthood. In older adults (65 + years), CKD Stage 4 (66.81%) emerged as the leading cause, reflecting the increasing role of chronic diseases, particularly kidney disease, in anemia prevalence among the elderly population.

A comparison of the 2021 data with 1990 reveals several shifts in the top causes of anemia in Vietnam. In 1990, iron deficiency was the leading cause across most age groups, with higher prevalence rates compared to 2021. For instance, iron deficiency contributed to 11.57% of anemia cases in infants in 1990, while in 2021, it reduced to 7.58%. This decline suggests improvements in nutrition and public health interventions targeting iron supplementation in younger children. Similarly, iron deficiency was more prevalent in early childhood in 1990 (21.52%) compared to 2021 (12.97%), further indicating progress in addressing micronutrient deficiencies.

The role of Vitamin A deficiency, however, remained prominent, particularly in early childhood. In 1990, it accounted for 61.41% of anemia cases in early childhood, and though slightly reduced, it still constituted 59.97% in 2021. This suggests that while there have been advancements in addressing iron deficiency, Vitamin A deficiency continues to be a persistent issue. In contrast to 1990, the prevalence of hemoglobinopathies such as beta-thalassemia trait and other hemoglobinopathies became more pronounced in 2021. In 1990, beta-thalassemia trait accounted for 7.87% of anemia cases among infants, whereas by 2021, it had risen to 10.39% in adolescents and 25.60% in young adults. This increase reflects greater recognition and possibly improved diagnostic capabilities for genetic causes of anemia over time. In the older adult population (65 + years), a notable shift occurred from iron deficiency being the leading cause in 1990 (6.66%) to CKD Stage 4 (66.81%) becoming the predominant cause in 2021. This change illustrates the growing impact of chronic diseases, particularly kidney disease, on anemia among older adults. The rise in anemia linked to chronic kidney disease (CKD) in older adults highlights the transition from nutritional and infectious causes of anemia in younger populations to more chronic and degenerative conditions in aging individuals.

YLDs rate for anemia and severity level

Figure 5 presents anemia YLD rates (per 100,000 population) by severity for all ages and both male and female from 1990 to 2021. The total anemia YLD rate has declined from 715 in 1990 to 428 in 2021, reflecting an overall reduction in anemia-related disability. Mild anemia YLDs dropped from 47 to 34, moderate anemia from 515 to 310, and severe anemia from 153 to 84 during this period. Online Supplementary Fig. 3 presents male and female YLD rates and severity levels over the period. For males, the total anemia YLD rate decreased significantly from 465 in 1990 to 145 in 2021, with notable reductions in mild, moderate, and severe anemia YLDs. The total anemia YLD rate for females declined from 951 in 1990 to 710 in 2021, indicating reduced anemia-related disability. Over the past three decades, consistent decreases were observed in YLD rates for all female anemia severity levels.

Fig. 5
figure 5

Anemia YLDs (rate per 100,000 population) by severity for all ages and both sexes, 1990–2021

Source: Author’s computation from GBD Study-2021

Percentage distribution of YLDs due to anemia in Vietnam by sex and age

Figure 6 shows the percentage distribution of YLDs due to anemia in Vietnam by sex and age group for 1990 and 2021. The data highlights a significant shift in the anemia burden between genders over this period. In 1990, females accounted for 68.41% of the total anemia burden, while males made up 31.59%. However, by 2021, the burden on females had risen to 83.09%, marking a notable increase of nearly 15%. In contrast, the male burden decreased to 16.91%, indicating a substantial reduction in anemia prevalence among males. This widening gender disparity is particularly evident across all age groups, with females consistently bearing a greater share of the anemia burden. The trend is especially pronounced among adolescents (10–19 years) and young adults (20–39 years), where the female burden has significantly increased over time. In 1990, females already carried a larger proportion of anemia-related YLDs in these age groups, but this has further escalated by 2021. The persistent high anemia burden among young females may be linked to reproductive health factors, nutritional deficiencies, and socio-economic inequalities.

Fig. 6
figure 6

Percentage distribution of anemia YLDs in Vietnam by sex for all age groups, 1990–2021

Note: Percentage is calculated from the total anemia YLD numbers. Anemia YLDs of age categories and sex is reported in Supplementary Table 3

Source: Author’s computation from GBD Data-2021

Causes of anemia YLDs rate

Table 2 presents the ranking of YLDs rates (per 100,000 population) and the percent distribution of anemia-related YLDs by different causes in Vietnam for the years 1990 and 2021. In both 1990 and 2021, iron deficiency remained the leading cause of anemia, responsible for 67.44% of anemia YLDs in 1990 and increasing slightly to 68.79% in 2021. Although the YLDs rate for iron deficiency anemia decreased from 482.1 to 294.65 per 100,000 population over time, it still accounts for the largest share of anemia YLDs in Vietnam. The overall YLDs rate for all causes of anemia decreased from 714.8 per 100,000 population in 1990 to 428.33 in 2021. This reduction reflects progress in managing and reducing the anemia burden, though significant challenges remain. Shifts in other causes of anemia YLDs rates, such as other hemoglobinopathies, other NTDs (Neglected Tropical Diseases), and beta-thalassemia trait, were observed in 2021 compared to 1990. Decreases in Vitamin A deficiency and hookworm disease YLDs rates were noted in Vietnam in 2021 compared to 1990. Emerging contributions of chronic conditions, such as Chronic Kidney Disease (CKD), particularly stages 3 and 4, show increasing relevance as causes of anemia. The contribution of malaria (both PvPr and PfPr types) to anemia YLDs has drastically reduced over time, with rates nearly reaching zero in 2021. Anemia related to menstrual disorders and maternal hemorrhage continues to contribute to the overall burden, but remains relatively minor compared to other causes.

Table 2 Ranking of YLDs rate (per 100,000 population) and percent distribution of anemia YLDs by all causes in Vietnam in 1990 and 2021

Causes of anemia YLDs rate by sex and by age in Vietnam

Online Supplementary Figs. 4–5 illustrate the causes of anemia-related disability across age groups for males and females in 2021. In early childhood (0–9 years), both sexes, iron deficiency is the leading cause, contributing to the majority of YLDs in infants. This reflects the critical need for improved nutrition in early childhood for both boys and girls to prevent anemia, with iron deficiency being a common factor. During adolescence (10–19 years), the anemia burden drops significantly for both males and females. However, females continue to experience a higher anemia rate (136.61 YLDs) compared to males (80.04 YLDs). As individuals transition into young adulthood (20–39 years), the anemia burden continues to decline for both sexes, with females exhibiting 89.01 YLDs and males 68.72 YLDs. For females, iron deficiency remains a significant concern, particularly in reproductive years due to menstruation and pregnancy. In middle adulthood (40–64 years), the anemia burden remains relatively low for both sexes, though females have a slightly higher rate (91.71 YLDs) compared to males (76.44 YLDs).

In older adults (65 + years), there is a notable increase in the anemia burden for both sexes, with females experiencing a significantly higher rate (1003.29 YLDs) compared to males (762.08 YLDs). This sharp rise in anemia prevalence among older women may be associated with age-related factors such as malnutrition, chronic health conditions, and decreased nutrient absorption. Iron deficiency remains the leading cause of anemia in both sexes, though other factors like hemoglobinopathies and non-communicable diseases also begin to contribute more prominently in older adults. Overall, the YLDs data reveals that anemia disproportionately affects females across most age groups, particularly in adolescence, reproductive years, and older adulthood, with iron deficiency being the leading cause. While males also face a significant burden of anemia, the differences in prevalence between the sexes are most pronounced in adolescence and old age.

Linkage between the anemia burden and socio-economics factors

Table 3 presents the FMOLS (Fully Modified Ordinary Least Squares) regression results examining the relationship between socio-economic variables (HDI, GDI, GII) and anemia burden in Vietnam from 1990 to 2021. The dependent variables are the prevalence rate of anemia (columns 1–3) and the Years Lived with Disability (YLDs) rate (columns 4–6). Starting with the prevalence rate of anemia, the results show that HDI has a statistically significant negative relationship with anemia prevalence. Specifically, a 1 unit increase in HDI is associated with a 2.143-unit reduction in the anemia prevalence rate, suggesting that higher levels of human development substantially reduce the prevalence of anemia. Similarly, GDI shows a negative and significant coefficient of -1.824, indicating that improvements in gender development lead to a 1.824 unit decrease in the prevalence of anemia. These results suggest that both overall human development and gender equality play crucial roles in reducing the anemia burden. On the other hand, the Gender Inequality Index (GII) has a positive and significant association with anemia prevalence, with a coefficient of 1.523. This means that a 1 unit increase in GII, indicating greater gender inequality, results in a 1.523 unit rise in anemia prevalence. The positive relationship underscores the detrimental impact of gender inequality on public health, particularly on anemia. Thus, policies that reduce gender inequality may contribute significantly to alleviating anemia in Vietnam.

In the case of YLDs rate, the findings are consistent with the prevalence results. A 1 unit increase in HDI leads to a 1.592-unit reduction in the YLDs rate, further supporting the idea that improved human development reduces the disability burden associated with anemia. Similarly, GDI is associated with a 1.146 unit decrease in the YLDs rate, suggesting that improvements in gender development lessen the disability impact of anemia. Conversely, GII has a positive and significant coefficient of 1.048, indicating that greater gender inequality results in higher disability burdens from anemia. The time trend variable in the models for both prevalence and YLDs shows a negative and significant relationship, suggesting that the anemia burden in Vietnam has generally been decreasing over the period from 1990 to 2021.

In conclusion, the regression results highlight the critical role of socio-economic factors in shaping the anemia burden in Vietnam. Higher human development and gender equality significantly reduce both anemia prevalence and the disability burden associated with it, while gender inequality exacerbates the problem. The findings underscore the importance of continuing efforts to improve socio-economic conditions and reduce gender inequality to combat anemia effectively.

Table 3 FMOLS regression result of anemia burden in Vietnam from 1990 to 2021

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