Estimating iron deficiency burden among healthcare-seeking Saudi women and children: Secondary analysis of multisource surveillance data (2014–2024)

Objectives: Iron deficiency anemia (IDA) represents a significant public health challenge worldwide, yet comprehensive national-level data from Saudi Arabia remain limited. This study aimed to quantify the burden of IDA across demographic groups in Saudi Arabia, identify key risk factors, analyze temporal trends from 2014 to 2024, and examine regional variations to inform Vision 2030 health priorities. Materials and Methods: We conducted a secondary analysis of publicly available aggregate data from multiple sources, including a nationwide laboratory-based surveillance dataset comprising 420,956 individuals tested between January 2014 and February 2024 across all 13 administrative regions, as reported by Radhwi et al. . This dataset reflects a healthcare-seeking population tested through a private-sector, fee-for-service diagnostic network and should not be interpreted as a nationally representative probability sample. Additional data were extracted from the World Health Organization Global Health Observatory, Global Burden of Disease Study 2021 (GBD 2021), and 14 peer-reviewed epidemiological studies. Iron deficiency (ID) was defined as serum ferritin less than 30 ng/mL, consistent with World Health Organization recommendations for populations with prevalent inflammation, while IDA was defined as hemoglobin less than 12 g/dL for women and 13 g/dL for men with concurrent ID. Descriptive statistics and chi-square tests were performed on the surveillance dataset. Adjusted odds ratios were derived exclusively from multivariate logistic regression models in the primary source studies. Statistical significance was set at P < 0.05. Results: Among the laboratory surveillance cohort, IDA prevalence was 19.8%, with nonanemic ID affecting an additional 23.7%, yielding a combined ID prevalence of 43.5%. Women constituted 93% of all IDA cases. Among infants aged 6–24 months attending primary healthcare centers, the IDA prevalence reached 49%. Significant regional variation was observed, ranging from 28% in Al-Jouf to 42% in the Makkah region ( P < 0.001). Key risk factors included family history of IDA (adjusted odds ratio [OR]: 2.91, 95% confidence interval [CI]: 1.78–4.76, P < 0.01), infrequent meat consumption (adjusted OR: 1.54, 95% CI: 1.15–2.05, P < 0.01), and short birth intervals (OR: 2.23, 95% CI: 1.20–4.41). GBD 2021 data demonstrated a 44.5% decline in age-standardized years lived with disability owing to dietary ID between 1990 and 2021 (95% uncertainty interval: −54.5% to −32.7%). Conclusions: Despite improvements over three decades, IDA remains a severe public health problem in Saudi Arabia, particularly affecting women of reproductive age and infants. The disproportionate burden on females (93% of cases) and substantial regional disparities necessitate targeted interventions aligned with Saudi Vision 2030 health transformation goals. Strengthening primary care screening, dietary education programs, and iron supplementation initiatives should be prioritized.