Iron Deficiency and Iron‐Deficiency Anemia Among Reproductive‐Age Women in the United States: Prevalence and Disparities, 2015–2023

Abstract

Introduction Iron deficiency (ID) and iron‐deficiency anemia (IDA) remain highly prevalent among U.S. reproductive‐age women, with substantial racial, ethnic, and socioeconomic disparities. This study examined the contemporary burden of ID and IDA among U.S. reproductive‐age women using inflammation‐adjusted diagnostic criteria and an explicit health equity framework. Methods Cross‐sectional analysis of 3322 women aged 18–49 years from the National Health and Nutrition Examination Survey (2015–2023). ID and IDA were defined using World Health Organization 2020 inflammation‐adjusted ferritin thresholds incorporating C‐reactive protein. Multivariable logistic regression examined associations between sociodemographic factors and iron status outcomes. Results Among nonpregnant women (n = 3156), 27.4% had ID and 8% had IDA. Among pregnant women (n = 166), 75.5% had ID and 8.3% had IDA. Non‐Hispanic Black women had 2.8‐fold higher odds of IDA (adjusted odds ratio [aOR] 2.8, 95% CI 1.6, 4.9). Obesity was independently associated with ID (aOR 2.4, 95% CI 1.86, 3.24) in nonpregnant women and pregnant women (aOR 4.5, 95% CI 1.08, 18.76). Racial and ethnic disparities persisted after adjustment for education, income, and food security. Conclusions ID and IDA remain highly prevalent among U.S. reproductive‐age women, with substantial and persistent racial, ethnic, and socioeconomic disparities. As a preventable and treatable condition with significant impacts on quality of life and pregnancy outcomes, it warrants greater clinical and public health attention, particularly among non‐Hispanic Black women, Hispanic women, women with obesity, and those experiencing socioeconomic disadvantages.