In 2021, the prevalence of pediatric anemia, defined as anemia among individuals under the age of 20, exhibited substantial variation across countries in Asia. South Korea reported the lowest prevalence, with 3175.62 per 100,000 population [95% uncertainty interval (UI) 2467.63–4109.04], whereas Bhutan recorded the highest, with 54,787.41 per 100,000 population (95% UI 46,951.92–64,749.77). Bhutan was followed by Pakistan (48,726.70 per 100,000; 95% UI 42,833.66–55,652.47), India (46,459.18 per 100,000; 95% UI 44,453.47–48,840.67), Yemen (45,933.97 per 100,000; 95% UI 42,628.42–49,327.18), and Myanmar (40,786.87 per 100,000; 95% UI 34,251.79–48,703.97). Notably, in Yemen, 19.2% of anemia cases were classified as severe, indicating that children and adolescents in this region are experiencing serious health consequences associated with anemia.

While this study provides a clear comparison of anemia prevalence between 1990 and 2021, we conducted an additional analysis to examine the country-specific trends in anemia prevalence from 1990 to 2021 (Fig. 1). This analysis revealed an overall declining trend in most countries, with the rates and patterns of decline varying across countries. In China, which experienced rapid economic growth over this period, anemia incidence decreased markedly from 15,055.08 per 100,000 in 1990 (95% UI 14,371.47–15,747.35) to 5626.62 per 100,000 in 2021 (95% UI 5300.04–5999.43). Similarly, South Korea experienced a steep decline in anemia incidence from 7900.87 per 100,000 in 1990 (95% UI 9990.50–14,371.47), reaching below 4000 per 100,000 in the early 2000s, followed by a slower downward trend. In Japan, anemia prevalence began at a relatively low level of 6523.96 per 100,000 in the 1990s (95% UI 4152.64–10,899.23) and declined gradually over the subsequent three decades. These trends suggest that while rapid economic development can significantly reduce anemia incidence, the rate of decline may plateau once a certain threshold is reached.

Trends in the prevalence of anemia among individuals under 20 years of age, 1990–2021. The image was generated from the same dataset (GBD 2021) as the original publication. GBD Global Burden of Disease Study

In contrast to the positive trends observed in high-socio-demographic index (SDI) or rapidly developing countries, many low-SDI countries, characterized by lower income per capita, fewer years of education, and higher fertility rates in females under the age of 25 [4], did not experience significant reductions in anemia burden. In particular, Bhutan and Myanmar showed little to no improvement, and Yemen even exhibited a slight increase in prevalence. In terms of the absolute number of anemia cases, both Yemen and Afghanistan experienced substantial increases over the past 30 years, with prevalence rates increasing by 108.34% and 130.28%, respectively. Unlike high-SDI countries, which showed both a low prevalence and a substantial decline in prevalence numbers and YLDs, many low-SDI countries not only maintained a high prevalence with minimal declines but also experienced significant increases in both the number of prevalent cases and YLDs. These findings underscore the urgency of intervention, suggesting that without appropriate measures, the burden of anemia will continue to worsen in these regions. While high-SDI countries have significantly reduced their anemia burden through access to nutritious food and robust healthcare systems, low-SDI countries have experienced increasing anemia rates due to poverty, malnutrition, and poor healthcare access. The situation is particularly severe in war-affected countries such as Afghanistan and Yemen, where armed conflict has triggered food crises [5] and caused the collapse of healthcare systems [6], likely worsening the anemia burden.

The male‒female (M/F) ratio, which illustrates disparities in anemia incidence and YLDs by sex and age group (Fig. 2), revealed that sex-related disparities were pronounced in the older age group (10–19 years). In this age group, females presented substantially greater anemia incidence and YLDs than males did. Increased iron requirements among females of reproductive age due to menstruation, combined with unequal food distribution within households in resource-constrained settings [7], may contribute to these disparities. Women, adolescents, and children under five years of age in low-SDI countries are particularly vulnerable to anemia and therefore require urgent, targeted policy interventions and support.

Male‒female ratios of prevalence rates and YLD rates (per 100,000 population) for pediatric anemia, stratified by sociodemographic index and age group in 2021. The image was generated from the same dataset (GBD 2021) as the original publication. YLD years lived with disability