Early childhood hemoglobin level is a strong predictor of hemoglobin levels during later childhood among low-income Alaska children.

OBJECTIVES

For unknown reasons, Arctic Indigenous children have iron deficiency and anemia prevalences up to 10 times higher than national reference populations. The current study sought to identify the importance of Alaska Native status, residence and hemoglobin (Hb) level at age 10 to 23 months for predicting Hb levels at age 24 to 59 months when controlling for potential confounders.

STUDY DESIGN

Retrospective cohort.

METHODS

A birth certificate database was linked to a database containing hemoglobin levels determined through the U.S. Supplemental Nutrition Program for Women, Infants and Children (WIC) among Alaskan children age 10 to 59 months evaluated from 1999-2006.

RESULTS

Of children with a birth certificate matched to WIC data, Alaska Native status and residence in western and northern Alaska were associated strongly with anemia at both ages. Nevertheless, of 5,796 children with Hb levels determined at both ages, the single strongest predictor of Hb level at age 24 to 59 months was Hb level at age 10 to 23 months. The community-level anemia prevalence among children age 10 to 23 months was predictive of community-level anemia prevalence among children age 24 to 59 months.

CONCLUSIONS

The early onset of anemia and the strong association between earlier and later Hb levels or anemia at both the individual and community levels suggest a role for prenatal effects that remain until at least age 5 years. This is true particularly of Yupik and Inupiat children, who make up the primary residents of western and northern Alaska.