Association between anemia and lower socioeconomic status: The mediating role of frailty

Anemia is a global health issue linked to malnutrition and chronic diseases. While its impact on children's learning is established, its broader socioeconomic implications in adults, particularly the mediating role of frailty, remain unclear. This study analyzed National Health and Nutrition Examination Survey data (2007-2018) from 22,851 United States adults (18-79 years). Anemia was defined by hemoglobin levels (men: < 130 g/L; women: < 120 g/L). Frailty was assessed using a modified Fried phenotype (weakness, low activity, exhaustion, slow gait, weight loss). Socioeconomic status (SES) was evaluated using income, education, occupation, and insurance, categorized into High/Low SES via latent class analysis. Weighted logistic regression analyzed anemia-SES associations, stratified by sex, with frailty mediation assessed. Anemia was significantly associated with lower SES in both sexes (male: odds ratio [OR] = 0.57, 95% confidence interval: 0.47-0.68; female: OR = 0.78, 95% confidence interval: 0.69-0.88, P < .001). Frailty alone also strongly predicted lower SES (OR = 0.45 for both sexes, P < .001). Coexisting anemia and frailty showed the strongest negative association (male: OR = 0.32; female: OR = 0.40, P < .001). Frailty mediated a significant portion of the anemia-SES link (male: 12.8%; female: 8.88%, P < .001). Anemia is associated with lower SES in adults, with frailty potentially partly accounting for this association. This highlights the potential value of integrated anemia management addressing both physiological symptoms and socioeconomic support to improve overall outcomes.