J Clin Med Res

Journal of Clinical Medicine Research, ISSN 1918-3003 print, 1918-3011 online, Open Access

Article copyright, the authors; Journal compilation copyright, J Clin Med Res and Elmer Press Inc

Journal website http://www.jocmr.org

Original Article

Volume 9, Number 12, December 2017, pages 970-980

Prevalence, Comorbidity and Investigation of Anemia in the Primary Care Office

Figure 3. Comparison of racial distributions in patients without anemia (a), mild anemia (b), and moderate anemia (c).

Figure 6. Comparison of patients with mild versus moderate anemia who received further diagnostic testing.

**Table 1.** Baseline Demographics of All Patients (N = 499)
Variable	Percentage of patients
Male
Female	59.5
Race
Caucasian	73.3
African-American	10.6
Hispanic	8.6
Asian	2.4
Other	5.1
Social history
Current smoker	11.6
Former smoker	28.1
Never smoker	60.3
Active alcohol use	61.7
Family history of hereditary anemia
Sickle cell anemia	0.2
Thalassemia	0
RBC membrane defect	0
Other	0.6
No family history of anemia	99.1
Personal history of anemia
Sickle cell	0.2
Thalassemia	0.4
RBC membrane defect	0
No personal history of anemia	90.7
Other	8.4
Comorbidities
Diabetes mellitus	17.2
Essential hypertension	45.3
Hypothyroidism	12.8
Chronic kidney disease	4.6
Malignancy	10
Rheumatologic disease	3.8
Chronic liver disease	4
Congestive heart failure	2.8
Coronary artery disease	10.2
Chronic obstructive pulmonary disease	3
Average age	56.3 years
Average BMI	29.4 kg/m²

Table 1. Baseline Demographics of All Patients (N = 499)

Variable

Percentage of patients

Male

Female

59.5

Race

Caucasian

73.3

African-American

10.6

Hispanic

8.6

Asian

2.4

Other

5.1

Social history

Current smoker

11.6

Former smoker

28.1

Never smoker

60.3

Active alcohol use

61.7

Family history of hereditary anemia

Sickle cell anemia

0.2

Thalassemia

RBC membrane defect

Other

0.6

No family history of anemia

99.1

Personal history of anemia

Sickle cell

0.2

Thalassemia

0.4

RBC membrane defect

No personal history of anemia

90.7

Other

8.4

Comorbidities

Diabetes mellitus

17.2

Essential hypertension

45.3

Hypothyroidism

12.8

Chronic kidney disease

4.6

Malignancy

Rheumatologic disease

3.8

Chronic liver disease

Congestive heart failure

2.8

Coronary artery disease

10.2

Chronic obstructive pulmonary disease

Average age

56.3 years

Average BMI

29.4 kg/m²

**Table 2.** Demographic Comparison of Patients Without Anemia to Patients With Anemia
	Patients without anemia (N = 389), %	Patients with anemia (N = 108), %	P value
Male	44.5	20.3	< 0.0001
Female	55	79.6	< 0.0001
Race
Caucasian	77.9	56.5	< 0.0001
African-American	7.5	24	< 0.0001
Hispanic	7.2	5.5	< 0.0001
Asian	2.3	2.8	< 0.0001
Other	5.1	3.7	< 0.0001
Social history
Current smoker	12.1	10.2	0.5873
Former smoker	26.9	32.4	0.2689
Never smoker	60.9	57.4	0.5092
Active alcohol use	67.8	54.6	0.0846
Family history of hereditary anemia
Sickle cell anemia	0.3	0	0.5691
Thalassemia	0	0
RBC membrane defect	0	0
Other	0	0
No family history of anemia	99.7	100	0.5691
Personal history of anemia
Sickle cell	0	0.93	0.0572
Thalassemia	0.3	0.93	0.3803
RBC membrane defect	0	0
No personal history of anemia	97.4	67.6	< 0.0001
Other	2.3	30.5	< 0.0001

Table 2. Demographic Comparison of Patients Without Anemia to Patients With Anemia

Patients without anemia (N = 389), %

Patients with anemia (N = 108), %

P value

Male

44.5

20.3

< 0.0001

Female

79.6

< 0.0001

Race

Caucasian

77.9

56.5

< 0.0001

African-American

7.5

< 0.0001

Hispanic

7.2

5.5

< 0.0001

Asian

2.3

2.8

< 0.0001

Other

5.1

3.7

< 0.0001

Social history

Current smoker

12.1

10.2

0.5873

Former smoker

26.9

32.4

0.2689

Never smoker

60.9

57.4

0.5092

Active alcohol use

67.8

54.6

0.0846

Family history of hereditary anemia

Sickle cell anemia

0.3

0.5691

Thalassemia

RBC membrane defect

Other

No family history of anemia

99.7

100

0.5691

Personal history of anemia

Sickle cell

0.93

0.0572

Thalassemia

0.3

0.93

0.3803

RBC membrane defect

No personal history of anemia

97.4

67.6

< 0.0001

Other

2.3

30.5

< 0.0001

**Table 3.** Comparison of Comorbidities in Patients Without Anemia to Patients With Anemia
Comorbidities	Patients without anemia (N = 389), %	Patients with anemia (N = 108), %	P value
Diabetes mellitus	16.4	19.4	0.4651
Essential hypertension	41.1	59.3	0.0008
Hypothyroidism	10.5	21.3	0.003
Chronic kidney disease	2.3	11.1	0.0001
Malignancy	7.7	18.5	0.001
Rheumatologic disease	2.8	7.4	0.0269
Chronic liver disease	3.3	6.5	0.1355
Congestive heart failure	1.8	6.5	0.0091
Coronary artery disease	7.9	18.5	0.0014
Chronic obstructive pulmonary disease	2.3	5.6	0.08
Average age	54.5 years	62.6 years	< 0.0001
Average BMI	29 kg/m²	30.5 kg/m²	0.054
Average number of comorbid illnesses	0.96	1.74	< 0.0001

Table 3. Comparison of Comorbidities in Patients Without Anemia to Patients With Anemia

Comorbidities

Patients without anemia (N = 389), %

Patients with anemia (N = 108), %

P value

Diabetes mellitus

16.4

19.4

0.4651

Essential hypertension

41.1

59.3

0.0008

Hypothyroidism

10.5

21.3

0.003

Chronic kidney disease

2.3

11.1

0.0001

Malignancy

7.7

18.5

0.001

Rheumatologic disease

2.8

7.4

0.0269

Chronic liver disease

3.3

6.5

0.1355

Congestive heart failure

1.8

6.5

0.0091

Coronary artery disease

7.9

18.5

0.0014

Chronic obstructive pulmonary disease

2.3

5.6

0.08

Average age

54.5 years

62.6 years

< 0.0001

Average BMI

29 kg/m²

30.5 kg/m²

0.054

Average number of comorbid illnesses

0.96

1.74

< 0.0001

**Table 4.** Comparison of Patients With Mild Anemia to Patients With Moderate Anemia
	Patients with mild anemia (N = 65), %	Patients with moderate anemia (N = 43), %	P value
Male	29.2	16.2	0.125
Female	70.7	83.7	0.125
Race
Caucasian	60.0	51.2	< 0.0001
African-American	18.5	32.6	< 0.0001
Hispanic	15.4	9.3	< 0.001
Asian	3.1	2.3	< 0.001
Other	3.1	4.7	< 0.001
Social history
Current smoker	9.2	11.6	0.6882
Former smoker	35.4	27.9	0.4185
Never smoker	55.4	60.5	0.6029
Active alcohol use	60.0	44.2	0.1083
Family history of hereditary anemia
Sickle cell anemia	0	2.3	0.2215
Thalassemia	0	2.3	0.2215
RBC membrane defect	0	0
Other	0	51.2	< 0.0001
No family history of anemia	100	44.2	< 0.0001
Personal history of anemia
Sickle cell	0	2.3	0.2215
Thalassemia	0	2.3	0.2215
RBC membrane defect	0	0
No personal history of anemia	16.9	44.2	< 0.0001
Other	83.1	51.2	0.0002
Mean corpuscular volume (MCV), fL/cell
< 80	30.2	4.6	0.0003
80 - 94	58.1	73.8	0.0893
> 94	11.6	21.5	0.1875

Table 4. Comparison of Patients With Mild Anemia to Patients With Moderate Anemia

Patients with mild anemia (N = 65), %

Patients with moderate anemia (N = 43), %

P value

Male

29.2

16.2

0.125

Female

70.7

83.7

0.125

Race

Caucasian

60.0

51.2

< 0.0001

African-American

18.5

32.6

< 0.0001

Hispanic

15.4

9.3

< 0.001

Asian

3.1

2.3

< 0.001

Other

3.1

4.7

< 0.001

Social history

Current smoker

9.2

11.6

0.6882

Former smoker

35.4

27.9

0.4185

Never smoker

55.4

60.5

0.6029

Active alcohol use

60.0

44.2

0.1083

Family history of hereditary anemia

Sickle cell anemia

2.3

0.2215

Thalassemia

2.3

0.2215

RBC membrane defect

Other

51.2

< 0.0001

No family history of anemia

100

44.2

< 0.0001

Personal history of anemia

Sickle cell

2.3

0.2215

Thalassemia

2.3

0.2215

RBC membrane defect

No personal history of anemia

16.9

44.2

< 0.0001

Other

83.1

51.2

0.0002

Mean corpuscular volume (MCV), fL/cell

< 80

30.2

4.6

0.0003

80 - 94

58.1

73.8

0.0893

> 94

11.6

21.5

0.1875

**Table 5.** Comparison of Patients With Mild Anemia to Patients With Moderate Anemia
Comorbidities	Patients with mild anemia (N = 65), %	Patients with moderate anemia (N = 43), %	P value
Diabetes mellitus	20	18.6	0.8578
Essential hypertension	61.5	55.8	0.557
Hypothyroidism	20	23.3	0.6877
Chronic kidney disease	9.2	11.6	0.6851
Malignancy	20	16.2	0.6201
Rheumatologic disease	6.15	9.3	0.5424
Chronic liver disease	6.15	6.9	0.866
Congestive heart failure	6.15	4.7	0.7401
Coronary artery disease	16.9	18.6	0.8211
Chronic obstructive pulmonary disease	4.6	6.9	0.6
Average age	64.8 years	59 years	0.1127
Average BMI	29.7 kg/m²	31.9 kg/m²	0.186
Average number of comorbid illnesses	1.76	1.72	0.8799

Table 5. Comparison of Patients With Mild Anemia to Patients With Moderate Anemia

Comorbidities

Patients with mild anemia (N = 65), %

Patients with moderate anemia (N = 43), %

P value

Diabetes mellitus

18.6

0.8578

Essential hypertension

61.5

55.8

0.557

Hypothyroidism

23.3

0.6877

Chronic kidney disease

9.2

11.6

0.6851

Malignancy

16.2

0.6201

Rheumatologic disease

6.15

9.3

0.5424

Chronic liver disease

6.15

6.9

0.866

Congestive heart failure

6.15

4.7

0.7401

Coronary artery disease

16.9

18.6

0.8211

Chronic obstructive pulmonary disease

4.6

6.9

0.6

Average age

64.8 years

59 years

0.1127

Average BMI

29.7 kg/m²

31.9 kg/m²

0.186

Average number of comorbid illnesses

1.76

1.72

0.8799

**Table 6.** Percentage of Patients That Underwent Further Laboratory Investigation for Anemia
	Patients with mild anemia (N = 65), %	Patients with moderate anemia (N = 43), %	P value
Iron	41.5	62.8	0.0314
Total iron binding capacity (TIBC)	24.6	46.5	0.0187
Ferritin	24.6	44.1	0.0342
Folic acid	21.5	23.2	0.8343
Cobalamin	41.5	37.2	0.6543
Fecal occult blood	7.7	18.6	0.0895
Reticulocytes	7.7	18.6	0.0895
Serum protein electrophoresis	1.5	6.9	0.1448

Table 6. Percentage of Patients That Underwent Further Laboratory Investigation for Anemia

Patients with mild anemia (N = 65), %

Patients with moderate anemia (N = 43), %

P value

Iron

41.5

62.8

0.0314

Total iron binding capacity (TIBC)

24.6

46.5

0.0187

Ferritin

24.6

44.1

0.0342

Folic acid

21.5

23.2

0.8343

Cobalamin

41.5

37.2

0.6543

Fecal occult blood

7.7

18.6

0.0895

Reticulocytes

7.7

18.6

0.0895

Serum protein electrophoresis

1.5

6.9

0.1448