Prevalence and causes of anemia among older adults in India: findings from wave 2 of the Harmonized Diagnostic Assessment of Dementia for the Longitudinal Aging Study in India (LASI-DAD) – International Journal for Equity in Health

Report on Anemia Prevalence Among Older Adults in India: A Sustainable Development Goals Perspective

Introduction: Anemia as a Barrier to Sustainable Development

The Longitudinal Ageing Study in India – Diagnostic Assessment of Dementia (LASI-DAD) provides critical data on the health of India’s elderly population. This report analyzes its findings on anemia prevalence among adults aged 60 and above, framing the issue within the context of the United Nations Sustainable Development Goals (SDGs). The high prevalence of anemia, affecting nearly half of this demographic, presents a significant challenge to achieving key SDG targets related to health, nutrition, gender equality, and reduced inequalities.

Key Findings of the LASI-DAD Study

The study presents a comprehensive national and regional evaluation of anemia, highlighting several critical areas for public health intervention.

• High National Prevalence: Nearly 50% of older adults in India are anemic, confirming anemia as a major public health concern for this demographic.
• Gender Disparity: The prevalence of both overall and nutritional anemia is significantly higher among women, underscoring a gender gap in health outcomes that aligns with the concerns of SDG 5 (Gender Equality).
• Primary Cause: Nutritional deficiency is the most common cause of anemia, directly impacting SDG 2 (Zero Hunger), which aims to end all forms of malnutrition.
  1. Iron deficiency anemia is the most prevalent type.
  2. Anemia from multiple nutritional deficiencies (e.g., iron, vitamin B12, folate) is the second most common form.
• Methodological Strength: The study’s use of a nationally representative sampling design and standardized, centralized laboratory methods provides robust and reliable estimates, addressing limitations of previous smaller-scale or hospital-based studies.

Implications for Sustainable Development Goals (SDGs)

The study’s findings reveal that anemia in India’s elderly is a multi-faceted issue that intersects with several core SDGs, hindering progress towards the 2030 Agenda.

SDG 3: Good Health and Well-being

The high prevalence of anemia directly undermines the goal of ensuring healthy lives and promoting well-being for all at all ages. Anemia is linked to increased morbidity and mortality, impacting the quality of life for a substantial portion of the aging population. The study identified significant non-nutritional causes of anemia, including:

• Anemia of chronic disease/inflammation (contributing to 40% of non-nutritional cases).
• Anemia related to Chronic Kidney Disease (CKD).

Addressing these underlying health conditions is essential for making progress on SDG 3 and promoting healthy aging.

SDG 2: Zero Hunger

The dominance of nutritional deficiencies as the primary driver of anemia highlights a critical failure in ensuring adequate nutrition for older adults. This directly contravenes Target 2.2, which aims to end all forms of malnutrition by 2025. The findings call for targeted nutritional programs and policies focused on the elderly to ensure access to iron, vitamin B12, and folate-rich diets.

SDG 10: Reduced Inequalities

The LASI-DAD study uncovers significant geographical disparities, a key concern of SDG 10. These inequalities demand tailored public health strategies that go beyond a one-size-fits-all national approach.

• Regional Hotspots: Anemia prevalence is substantially higher in Eastern and Northeastern states (Region 4: Assam, West Bengal, Jharkhand, Odisha, and Chhattisgarh) compared to other regions.
• Differing Causes: This regional disparity is largely attributed to a higher prevalence of non-nutritional and unexplained anemia in these states.
• Policy Implications: The data suggests that while addressing iron deficiency is a national priority, region-specific strategies are required to tackle other underlying causes, such as chronic diseases and potentially hemoglobinopathies, to effectively reduce anemia prevalence and close the health inequality gap.

Conclusion and Path Forward

The LASI-DAD study confirms that anemia among India’s elderly is a widespread public health crisis with deep roots in nutritional deficits, chronic disease, gender inequality, and regional disparities. Effectively tackling this challenge is not only a health imperative but also a crucial step towards achieving multiple Sustainable Development Goals.

Future actions should include:

1. Developing integrated health and nutrition policies that specifically target the elderly population, aligning with SDG 2 and SDG 3.
2. Implementing gender-sensitive programs to address the disproportionate burden of anemia on older women, in line with SDG 5.
3. Designing and deploying region-specific interventions to address the unique causes of anemia in high-prevalence areas like Eastern India, thereby advancing SDG 10.
4. Conducting further research into the causes of unexplained anemia, including the role of hemoglobinopathies, to inform more effective and targeted public health strategies.

Analysis of Sustainable Development Goals in the Article

1. Which SDGs are addressed or connected to the issues highlighted in the article?

1. SDG 2: Zero Hunger

   • The article’s central theme is the high prevalence of anemia, with a significant focus on “nutritional anemia.” It states that “nutritional deficiency is the most common cause of anemia among older adults” and specifically identifies “iron deficiency anemia,” “vitamin B12 and folate deficiency anemia” as major types. This directly relates to SDG 2, which aims to end hunger and all forms of malnutrition.

2. SDG 3: Good Health and Well-being

   • The study addresses the health status of a specific demographic, “older adults aged 60 years and above in India.” Anemia is a serious health condition that impacts well-being. The article’s investigation into the prevalence, causes (including non-nutritional ones like “anemia of chronic disease/inflammation” and those related to CKD), and regional distribution of anemia aligns with SDG 3’s goal of ensuring healthy lives for all at all ages.

3. SDG 5: Gender Equality

   • The article explicitly points out a gender disparity in health outcomes, stating that “the overall and nutritional anemia prevalences being higher among women.” This finding connects the issue to SDG 5, which aims to achieve gender equality and empower all women and girls, including addressing inequalities in health.

4. SDG 10: Reduced Inequalities

   • The analysis reveals significant inequalities within the country. The article highlights “substantial regional differences in anemia prevalence, with a higher prevalence in Eastern/Northeastern states.” It also notes that while not statistically significant, the “prevalence of anemia in our study was higher in rural areas than in urban areas.” These geographical and locational disparities are directly relevant to SDG 10’s objective of reducing inequality within and among countries.

2. What specific targets under those SDGs can be identified based on the article’s content?

1. Target 2.2: End all forms of malnutrition

   • This target aims to “end all forms of malnutrition… and address the nutritional needs of… older persons” by 2030. The article’s focus on the “high national prevalence of anemia among older adults” and its finding that “nutritional anemia” is the primary cause directly corresponds to this target. The study provides critical data on the nutritional status of the elderly in India.

2. Target 3.4: Reduce mortality from non-communicable diseases and promote mental health

   • This target focuses on reducing premature mortality from non-communicable diseases (NCDs) and promoting well-being. The article’s discussion of “non-nutritional anemia,” including “anemia of chronic disease/inflammation” and anemia related to “Chronic Kidney Disease (CKD),” links directly to the management of chronic health conditions in the elderly, which is a core component of achieving this target.

3. Target 10.2: Promote universal social, economic and political inclusion

   • This target aims to “empower and promote the social, economic and political inclusion of all, irrespective of age, sex… or other status.” The article’s analysis of anemia prevalence disaggregated by age (older adults), sex (higher in women), and geographic location (regional and rural/urban disparities) provides evidence of health inequalities affecting specific groups, which must be addressed to achieve inclusive well-being.

3. Are there any indicators mentioned or implied in the article that can be used to measure progress towards the identified targets?

1. Prevalence of Anemia in Older Adults

   • The article provides direct quantitative data for this indicator. It states, “nearly half of the older adults had anemia,” and specifies the prevalence increased to “49.9%.” This serves as a direct measure of malnutrition (Target 2.2) and the overall health status (SDG 3) of the elderly population.

2. Prevalence of Anemia by Cause

   • The study categorizes anemia, providing a detailed breakdown that can be used as an indicator. It identifies the prevalence of “nutritional anemia” (the most common cause), “iron deficiency anemia” (the most common nutritional type), “non-nutritional anemia,” and “anemia of chronic disease/inflammation.” This helps in monitoring the specific drivers of poor health and malnutrition.

3. Prevalence of Anemia Disaggregated by Sex, Region, and Location

   • The article provides disaggregated data which are crucial indicators for measuring inequality (SDG 10 and SDG 5).
     • By Sex: The finding that prevalence is “higher among women” is a key indicator of gender-based health inequality.
     • By Region: The data showing a “higher prevalence in Eastern/Northeastern states” is an indicator of regional inequality.
     • By Location: The mention of prevalence being “higher in rural areas than in urban areas” serves as an indicator of urban-rural health disparities.

4. Summary Table of SDGs, Targets, and Indicators

Source: equityhealthj.biomedcentral.com