National temporal trends and demographic disparities in nutritional anemia-relatedmortality in the United States, 1999–2024

Abstract Background: Nutritional anemias remain a preventable cause of morbidity and mortality in the United States, disproportionately affecting vulnerable populations. Despite improvements in nutrition and healthcare access, emerging evidence suggests a recent reversal in progress. This study aimed to quantify national trends in nutritional anemia-related mortality and to characterize disparities by sex, race/ethnicity, and urbanization. Methods: We extracted mortality data from the Centers for Disease Control and Prevention Wide-ranging Online Data for Epidemiologic Research (CDC WONDER), including all U.S. deaths from January 1, 1999, through December 31, 2024, with an underlying cause of death coded as nutritional anemia (ICD-10 codes D50–D53). Age-adjusted mortality rates (AAMRs) per 100,000 population were calculated by direct standardization to the 2000 U.S. standard population. Temporal trends were evaluated using joinpoint regression to estimate annual percent change (APC) and average annual percent change (AAPC) overall and within subgroups defined by sex, race/ethnicity (non-Hispanic Black, non-Hispanic White, Hispanic), and urban–rural residence (based on the 2013 NCHS Urban–Rural Classification, available through 2020). Mortality data for 2024 are provisional. Results: From 1999 to 2024, 78,864 nutritional anemia-related deaths were recorded. The overall AAMR initially declined from 1.17 (95% CI: 1.13–1.21) per 100,000 in 1999, then reversed and rose to 1.39 (1.36–1.43) in 2024, corresponding to an AAPC of +0.85%. Males experienced persistently higher mortality than females (2024: 1.48 vs 1.34), but both sexes showed a notable rise after 2014, with an APC +11% [10.45 to 16.69] for females and +11.55% [10.21 to 15.29] for males. Non-Hispanic Black individuals had the highest AAMR throughout (1999: 1.46; 2024: 1.67), followed by non-Hispanic Whites (1.12 to 1.43), while Hispanic individuals maintained the lowest rates (0.97 to 0.98), with only modest changes over time. Racial disparities persisted, with the Black-to-White mortality rate ratio remaining above 1.1 in 2024. Rural residents consistently had higher mortality rates than urban residents (2024: 1.68 vs 1.02), and both groups experienced a sharp rise after 2014, especially in rural areas. Conclusions: After early declines through the 2000s, nutritional anemia mortality has increased substantially in the last decade across most groups with persistent and widening disparities by sex, race/ethnicity, and urban–rural residence. Males, non-Hispanic Black individuals, and rural populations remain at the highest rates. These findings underscore the urgent need for renewed public health strategies targeting at-risk groups and addressing the social determinants of nutritional health.