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Geographic and Racial Patterns of Anemia Prevalence Among Low-income Alaskan Children and Pregnant or Postpartum Women Limit Potential Etiologies

Gessner, Bradford D

Journal of Pediatric Gastroenterology & Nutrition: April 2009 - Volume 48 - Issue 4 - p 475–481
doi: 10.1097/MPG.0b013e3181888fac
Original Articles: Hepatology and Nutrition

Objectives: The etiology of the 10-fold increase in anemia and iron deficiency prevalence among Alaska Native individuals from the culturally traditional southwestern/northern Alaska regions remains unknown. The present study sought to determine anemia prevalence among people enrolled in the Alaska Women, Infant, and Children (WIC) program and reconcile results with etiological hypotheses, particularly nutritional iron deficiency and Helicobacter pylori infection.

Patients and Methods: An analysis was conducted of 50,964 children 6 to 59 months of age and 30,154 pregnant or postpartum women enrolled in WIC during 1999 to 2006. Based on 3 regional groupings of residence and Alaska Native status, 6 strata were defined.

Results: Southwestern/northern Alaska Native children—who are known to have high nutritional iron intake based on subsistence diets—had the highest anemia prevalence (35%). However, southwestern/northern residence increased anemia risk similarly for Alaska Native (relative risk 1.6) and non-Native (relative risk 1.5) children. Anemia prevalence was highest among the youngest children and declined with increasing age at approximately the same rate regardless of race or residence. Alaska Native pregnant or postpartum women from all of the regions had higher anemia prevalences than non-Native women; southwestern/northern residence conferred additional risk to Alaska Native women.

Conclusions: A region-specific environmental factor is supported by the increased risk seen among all of the children residing in the southwestern/northern regions. However, the observed patterns make nutritional iron deficiency or H pylori infection unlikely as the sole or major etiologies of the high anemia prevalences observed in some groups.

Alaska Division of Public Health, Anchorage

Received 2 May, 2008

Accepted 30 July, 2008

Address correspondence and reprint requests to Bradford D. Gessner, MD, MPH, Alaska Division of Public Health, PO Box 240249, 3601 C Street, Suite 424, Anchorage, AK 99524 (e-mail:

The present study was supported in part by project H18 MC-00004-11 from the Maternal and Child Health Bureau (Title V, Social Security Act), Health Resources and Services Administration, and Department of Health and Human Services.

The author reports no conflicts of interest.

© 2009 Lippincott Williams & Wilkins, Inc.