The prevalence comparison of iron deficiency anemia (IDA) between non-elderly and elderly, study in rural areas of Ubon Ratchathani and Si Sa Ket Province


  • Pattamaphorn Seansing Biomedical sciences Program, College of Medicine and Public Health, Ubon Ratchathani University
  • Nawinda Vanichakulthada College of Medicine and Public Health, Ubon Ratchathani University
  • Anuwat Pinyachat College of Medicine and Public Health, Ubon Ratchathani University


Prevalence, Anemia, Iron deficiency Anemia, Non-elderly, Elderly


There has never been a report comparing iron deficiency anemia between working age groups and elderly people living in the lower northeastern region of Thailand before. This research studied two sample groups: working people aged 18-59 years (146 people) and elderly people aged 60 years and over (147 people). The sample lived in rural areas in Ubon Ratchathani and Si Sa Ket provinces, where the prevalence of anemia was found to be high and caused by various causes. We use the 2022 World Health Organization (WHO) criteria to diagnose anemia using Hemoglobin (Hb) concentration. We use serum ferritin to indicate the amount of iron stored in the body and a C-reactive protein (CRP) test to indicate inflammation, both of which are used to diagnose iron deficiency. The results of the study found that the prevalence of anemia in the working age group compared to that in the elderly group was 39.7% and 58%, respectively, with the prevalence of anemia increasing with increasing age. The prevalence of iron deficiency in the working age group compared to the elderly group was 18.7% and 6%, respectively. Although iron deficiency anemia was found in working age people at 12.3%, more than in the elderly at 3.4%. However, anemia is found more in the elderly than in working people, which means that anemia in the elderly may be caused by other factors such as inflammation, chronic disease, malnutrition, abnormal iron absorption, etc. The median amount of iron stored in the body in the working age group was significantly lower than that in the elderly group (median 128.91 and 164.96 µg/L, respectively). This data indicates that serum ferritin, a type of acute phase protein, is released when the body is inflamed, especially in the elderly group. Therefore, diagnosing anemia among elderly people with chronic diseases is challenging. Future research to identify new markers to differentiate inflammation-related anemia from iron deficiency anemia is important.


WHO. Thailand’s leadership and innovations towards healthy ageing 2023 [Available from:

Noda S, Hernandez PMR, Sudo K, Takahashi K, Woo NE, Chen H, et al. Service Delivery Reforms for Asian Ageing Societies: A Cross-Country Study Between Japan, South Korea, China, Thailand, Indonesia, and the Philippines. Int J Integr Care. 2021;21(2):1.

Aekplakorn W, Puckcharern H, Satheannoppakao W. The Sixth Thai National Health Examination Survey. Aksorn graphic and design: Faculty of Medicine, Ramathibodi Hospital, Mahidol University; 2021.

Laudisio A, Marzetti E, Pagano F, Bernabei R, Zuccalà G. Haemoglobin levels are associated with bone mineral density in the elderly: a population-based study. Clin Rheumatol. 2009;28(2):145-51.

WHO. Global burden of 369 diseases and injuries in 204 countries and territories, 1990–2019: a systematic analysis for the Global Burden of Disease Study. Lancet. 2020;396:393.

Röhrig G, Doehner W, Schaefer RM, Schulz RJ. Anemia and iron deficiency in the elderly. Prevalence, diagnostics and new therapeutic options. Z Gerontol Geriatr. 2012;45(3):191-6.

Coban E, Timuragaoglu A, Meriç M. Iron deficiency anemia in the elderly: prevalence and endoscopic evaluation of the gastrointestinal tract in outpatients. Acta Haematol. 2003;110(1):25-8.

Deeruksa L, Sanchaisuriya K. Anemia in the Elderly in Northeastern Thailand: A Community-Based Study Investigating Prevalence, Contributing Factors, and Hematologic Features. Acta Haematol. 2017;138(2):96-102.

Weiss G, Goodnough LT. Anemia of chronic disease. N Engl J Med. 2005;352(10):1011-23.

Nemeth E, Ganz T. Hepcidin-Ferroportin Interaction Controls Systemic Iron Homeostasis. Int J Mol Sci. 2021;22(12).

Zhang DL, Wu J, Shah BN, Greutélaers KC, Ghosh MC, Ollivierre H, et al. Erythrocytic ferroportin reduces intracellular iron accumulation, hemolysis, and malaria risk. Science. 2018;359(6383):1520-3.

Smith DL. Anemia in the elderly. Am Fam Physician. 2000;62(7):1565-72.

Soppi ET. Iron deficiency without anemia - a clinical challenge. Clin Case Rep. 2018;6(6):1082-6.

Lanier JB, Park JJ, Callahan RC. Anemia in Older Adults. Am Fam Physician. 2018;98(7):437-42.

Patel KV. Epidemiology of anemia in older adults. Semin Hematol. 2008;45(4):210-7.

Karnpean R, Vanichakulthada N, Suwannaloet W, Thongrung R, Singsanan S, Prakobkaew N, et al. Anemia, iron deficiency, and thalassemia among the Thai population inhabiting at the Thailand-Lao PDR-Cambodia triangle. Sci Rep. 2022;12(1):18643.

Bunthupanich R, Karnpean R, Pinyachat A, Jiambunsri N, Prakobkaew N, Pakdee N, et al. Micromapping of Thalassemia and Hemoglobinopathies Among Laos, Khmer, Suay and Yer Ethnic Groups Residing in Lower Northeastern Thailand. Hemoglobin. 2020;44(3):162-7.

Cochran WG. Sampling Techniques. 3 ed. USA: John Wiley & Sons, Inc.; 1977.

Cappellini MD, Musallam KM, Taher AT. Iron deficiency anaemia revisited. J Intern Med. 2020;287(2):153-70.

Kumar A, Sharma E, Marley A, Samaan MA, Brookes MJ. Iron deficiency anaemia: pathophysiology, assessment, practical management. BMJ Open Gastroenterol. 2022;9(1).

Bouri S, Martin J. Investigation of iron deficiency anaemia Clin Med (Lond). 2018;18(3):242-4.

Dahlerup JF, Eivindson M, Jacobsen BA, Jensen NM, Jørgensen SP, Laursen SB, et al. Diagnosis and treatment of unexplained anemia with iron deficiency without overt bleeding. Dan Med J. 2015;62(4):C5072.

Dean L. Blood Groups and Red Cell Antigens (Table 1, Complete blood count): Bethesda (MD): National Center for Biotechnology Information (US); 2005. Available from:

Plengsuree S, Punyamung M, Yanola J, Nanta S, Jaiping K, Maneewong K, et al. Red Cell Indices and Formulas Used in Differentiation of β-Thalassemia Trait from Iron Deficiency in Thai Adults. Hemoglobin. 2015;39(4):235-9.

Karoopongse E, Srinonprasert V, Chalermsri C, Aekplakorn W. Prevalence of anemia and association with mortality in community-dwelling elderly in Thailand. Sci Rep. 2022;12(1):7084.

Bunthupanich R, Karnpean R, Pinyachat A, Jiambunsri N, Prakobkaew N. Anemia and thalassemia in the Kui (Suay) elderly living in Sisaket Province located at the lower Northeastern Thailand. Archives of Allied Health Sciences. 2020;32(3):32-8.

Pyae TW, Sanchaisuriya K, Athikamanon S, Sanchaisuriya P, Srivorakun H, Chaibunruang A, et al. Anemia in an ethnic minority group in lower northern Thailand: A community-based study investigating the prevalence in relation to inherited hemoglobin disorders and iron deficiency. PLoS One. 2023;18(6):e0287527.

Sukrat B, Suwathanapisate P, Siritawee S, Poungthong T, Phupongpankul K. The prevalence of iron deficiency anemia in pregnant women in Nakhonsawan, Thailand. J Med Assoc Thai. 2010;93(7):765-70.

Yanola J, Kongpan C, Pornprasert S. Prevalence of anemia, iron deficiency, thalassemia and glucose-6-phosphate dehydrogenase deficiency among hill-tribe school children in Omkoi District, Chiang Mai Province, Thailand. Southeast Asian J Trop Med Public Health. 2014;45(4):920-5.

Breymann C, Honegger C, Hösli I, Surbek D. Diagnosis and treatment of iron-deficiency anaemia in pregnancy and postpartum. Arch Gynecol Obstet. 2017;296(6):1229-34.

Romano AD, Paglia A, Bellanti F, Villani R, Sangineto M, Vendemiale G, et al. Molecular Aspects and Treatment of Iron Deficiency in the Elderly. Int J Mol Sci. 2020;21(11).

Lapić I, Padoan A, Bozzato D, Plebani M. Erythrocyte Sedimentation Rate and C-Reactive Protein in Acute Inflammation. Am J Clin Pathol. 2020;153(1):14-29.

Namaste SM, Rohner F, Huang J, Bhushan NL, Flores-Ayala R, Kupka R, et al. Adjusting ferritin concentrations for inflammation: Biomarkers Reflecting Inflammation and Nutritional Determinants of Anemia (BRINDA) project. Am J Clin Nutr. 2017;106(Suppl 1):359s-71s.

Muñoz M, Acheson AG, Bisbe E, Butcher A, Gómez-Ramírez S, Khalafallah AA, et al. An international consensus statement on the management of postoperative anaemia after major surgical procedures. Anaesthesia. 2018;73(11):1418-31.

Cappellini MD, Comin-Colet J, de Francisco A, Dignass A, Doehner W, Lam CS, et al. Iron deficiency across chronic inflammatory conditions: International expert opinion on definition, diagnosis, and management. Am J Hematol. 2017;92(10):1068-78.

Abitbol V, Borderie D, Polin V, Maksimovic F, Sarfati G, Esch A, et al. Diagnosis of Iron Deficiency in Inflammatory Bowel Disease by Transferrin Receptor-Ferritin Index. Medicine (Baltimore). 2015;94(26):e1011.

Jain S, Narayan S, Chandra J, Sharma S, Jain S, Malhan P. Evaluation of serum transferrin receptor and sTfR ferritin indices in diagnosing and differentiating iron deficiency anemia from anemia of chronic disease. Indian J Pediatr. 2010;77(2):179-83.

Kundrapu S, Noguez J. Chapter Six - Laboratory Assessment of Anemia. In: Makowski GS, editor. Advances in Clinical Chemistry. 83: Elsevier; 2018. p. 197-225.

Dewan P, Dixit A, Gomber S, Kotru M, Banerjee BD, Tyagi V, et al. Serum and Urinary Hepcidin for Diagnosing Iron-deficiency Anemia in Under-5 Children. J Pediatr Hematol Oncol. 2019;41(4):e216-e20.

Nanta N, Natesirinilkul R, Kittisakmontri K, Chimnuan K, Manowong S, Suanta S, et al. Screening for Iron Deficiency Anemia in Infants in a Thalassemia-endemic Region. J Pediatr Hematol Oncol. 2021;43(1):e11-e4.

Jamnok J, Sanchaisuriya K, Chaitriphop C, Sanchaisuriya P, Fucharoen G, Fucharoen S. A New Indicator Derived From Reticulocyte Hemoglobin Content for Screening Iron Deficiency in an Area Prevalent for Thalassemia. Lab Med. 2020;51(5):498-506.

Yamaji S, Sharp P, Ramesh B, Srai SK. Inhibition of iron transport across human intestinal epithelial cells by hepcidin. Blood. 2004;104(7):2178-80.

Corna G, Caserta I, Monno A, Apostoli P, Manfredi AA, Camaschella C, et al. The Repair of Skeletal Muscle Requires Iron Recycling through Macrophage Ferroportin. J Immunol. 2016;197(5):1914-25.

Camaschella C. New insights into iron deficiency and iron deficiency anemia. Blood Rev. 2017;31(4):225-33.

Finberg KE, Heeney MM, Campagna DR, Aydinok Y, Pearson HA, Hartman KR, et al. Mutations in TMPRSS6 cause iron-refractory iron deficiency anemia (IRIDA). Nat Genet. 2008;40(5):569-71.

Silvestri L, Pagani A, Nai A, De Domenico I, Kaplan J, Camaschella C. The serine protease matriptase-2 (TMPRSS6) inhibits hepcidin activation by cleaving membrane hemojuvelin. Cell Metab. 2008;8(6):502-11.

Hershko C, Camaschella C. How I treat unexplained refractory iron deficiency anemia. Blood. 2014;123(3):326-33.

แสดงร้อยละของภาวะโลหิตจาง แบ่งตามเพศและช่วงอายุ 4 ช่วง



How to Cite

Seansing P, Vanichakulthada N, Pinyachat A. The prevalence comparison of iron deficiency anemia (IDA) between non-elderly and elderly, study in rural areas of Ubon Ratchathani and Si Sa Ket Province. Health Sci Tech Rev [Internet]. 2023 Dec. 26 [cited 2024 May 18];16(3):70-84. Available from: