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American Journal of Epidemiology Advance Access originally published online on December 9, 2008
American Journal of Epidemiology 2009 169(3):355-364; doi:10.1093/aje/kwn355
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American Journal of Epidemiology © The Author 2008. Published by the Johns Hopkins Bloomberg School of Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oxfordjournals.org.

ORIGINAL CONTRIBUTIONS

Correlates of Anemia in American Blacks and Whites

The REGARDS Renal Ancillary Study

Neil A. Zakai, Leslie A. McClure, Ronald Prineas, George Howard, William McClellan, Chris E. Holmes, Britt B. Newsome, David G. Warnock, Paul Audhya and Mary Cushman

Correspondence to Dr. Mary Cushman, University of Vermont College of Medicine, 208 South Park Drive, Colchester, VT 05446 (e-mail: mary.cushman{at}uvm.edu).

Received for publication January 3, 2008. Accepted for publication September 24, 2008.

For unclear reasons, anemia is more common in American blacks than whites. The authors evaluated anemia prevalence (using World Health Organization criteria) among 19,836 blacks and whites recruited in 2003–2007 for the REasons for Geographic And Racial Differences in Stroke Renal Ancillary study and characterized anemia by 3 anemia-associated conditions (chronic kidney disease, inflammation, and microcytosis). They used multivariable models to assess potential causes of race differences in anemia. Anemia was 3.3-fold more common in blacks than whites, with little attenuation after adjusting for demographic variables, socioeconomic factors, and comorbid conditions. Increasing age, residence in the US southeast, lower income, vascular disease, diabetes, hypertension, and never smoking were associated with anemia. Age, diabetes, and vascular disease were stronger correlates of anemia among whites than blacks (P < 0.05). Among those with anemia, chronic kidney disease was less common among blacks than whites (22% vs. 34%), whereas inflammation (18% vs. 14%) and microcytosis (22% vs. 11%) were more common. In this large, geographically diverse cohort, anemia was 3-fold more common in blacks than whites with different characteristics and correlates. Race differences in anemia prevalence were not explained by the factors studied. Future research into the causes and consequences of anemia in different racial groups is needed.

anemia; chronic disease; health status disparities; kidney diseases; population groups

Abbreviations: CI, confidence interval; eGFR, estimated glomerular filtration rate; OR, odds ratio; REGARDS, REasons for Geographic And Racial Differences in Stroke


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