Prevalence and characteristics of anemia in Turkish adults insights from the PURE Türkiye Cohort

To determine the prevalence, severity, and morphological subtypes of anemia among adults aged 35–70 years in Türkiye and to examine their distribution according to sex, age, educational level, and urban–rural residence. Cross-sectional analysis of baseline data from a nationally representative prospective cohort study. Community-based study conducted in urban and rural areas across eight provinces in Türkiye. A total of 4,050 adults aged 35–70 years enrolled in the Prospective Urban Rural Epidemiology (PURE) Türkiye cohort between 2008 and 2009 with available hemoglobin measurements. Anemia was defined and classified according to World Health Organization criteria. Primary outcomes were the prevalence and severity of anemia. Secondary outcomes included morphological subtypes based on mean corpuscular volume, mean corpuscular hemoglobin concentration, and red cell distribution width, as well as associations with sociodemographic characteristics and estimated dietary iron and vitamin B12 intake. Overall, 13.6% of participants had anemia, with a significantly higher prevalence in women than in men (19.3% vs. 4.8%; p < 0.001). Microcytic anemia was the most common subtype (51.9%), followed by normocytic anemia (48.1%). Among individuals with anemia, approximately 37% had hypochromic microcytic anemia with elevated red cell distribution width, suggestive of iron deficiency. Anemia prevalence showed an inverse association with educational level ( p = 0.009) and was slightly higher in urban than in rural areas (14.4% vs. 12.2%; p = 0.049). Estimated dietary iron and vitamin B12 intake did not differ significantly across anemia subtypes or hemoglobin categories, except for lower vitamin B12 intake among anemic men. Anemia affects a substantial proportion of adults aged 35–70 years in Türkiye, particularly women and individuals with lower educational attainment. The predominance of hypochromic microcytic anemia indicates that iron deficiency and non-nutritional factors may play an important role. These findings support the need for targeted public health strategies and routine anemia screening in high-risk adult populations.