An epidemiological study on anemia among institutionalized people with intellectual and/or motor disability with special reference to its frequency, severity and predictors

BMC Public Health An epidemiological study on anemia among institutionalized people with intellectual and/or motor disability with special reference to its frequency, severity and predictors Hiroko Ohwada 2 Takeo Nakayama 1 Nobuo Nara 0 Yuji Tomono 3 Keiko Yamanaka 3 0 Department of Laboratory Medicine, Tokyo Medical and Dental University , 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8519 , Japan 1 Department of Health Informatics, Kyoto University School of Public Health , Yoshida-Konoe-cho, Sakyo-ku, Kyoto 606-8501 , Japan 2 Department of Food Sciences, Ibaraki Christian University , 6-11-1 Ohmika Hitachi, Ibaraki, 319-1295 , Japan 3 Ibaraki Prefectural Hospital of ASUNARO-NO-SATO , 1460 Sugizaki, Uchihara-machi, Higashiibaraki-gun, Ibaraki 319-0306 , Japan Background: To examine the type, frequency, severity, and predictors of anemia and its relationship with co-morbid conditions among institutionalized people with intellectual and/or motor disability. Methods: We conducted a cross-sectional study at a public facility for people with intellectual and/ or motor disability in Ibaraki prefecture, Japan. Health checkup data obtained in 2001 from 477 people with intellectual disability (male: 286, average age 40.6 12.3; female: 191, average age 45.1 11.6) were retrospectively reviewed. Results: The prevalence of anemia among male participants was higher than in female participants for each disability category (intellectual disability, 41.1%, 4.2%; cerebral palsy, 37.5%, 4.8%; Down's syndrome, 15.0%, 0%; severe motor and intellectual disabilities, 61.9%, 16.7%). Most participants with anemia (93.8 - 100%) showed a normocytic normochromic anemia pattern. Multivariate analysis revealed that factors related to an increase in frequency included sex (male), low body mass index (BMI), use of anticonvulsants or major tranquilizers, and a high zinc sulfate turbidity test (ZTT) value. No clinically diagnosed co-morbid condition was found to be related to the presence of anemia. Conclusion: A high frequency of mild normocytic normochromic anemia in institutionalized people with intellectual and/or motor disability was observed, particularly among males. Medications and chronic inflammation may increase the risk of anemia. - Background The 1992 American Association on Mental Retardation's (AAMR) definition and classification of mental retardation differs from the previous classification system in that: (a) a single diagnostic code of mental retardation is used if the individual meets the three criteria of age of onset (18 or under), significantly sub-average abilities in intellectual functioning, and related limitations in two or more adaptive skills areas; (b) the individual's strengths and weaknesses are described in reference to four dimensions: intellectual functioning and adaptive skills; psychological and emotional well-being; health, physical well-being, and etiology; and life activity environments; and (c) a profile of required support is developed across the four dimensions [1]. In recent years, interest in the quality of life of persons with intellectual disability has grown. However, epidemiological research on health and illness among people with intellectual disability has lagged when compared to similar research on healthy individuals. Many persons with intellectual disability in Japan lead a collective lifestyle at a public facility as a community. These facilities provide an adequate diet, occupational rehabilitation and periodic medical checkups [2] and are thus fairly accommodable to conducting epidemiologic research on people with intellectual disability. In the past, nutritionists at these facilities have recognized a high frequency of anemia among institutionalized people with intellectual disability. Nevertheless, there continues to be a lack of epidemiological studies on the actual frequency, pattern, and predictors of anemia. The accumulation of relevant findings on this subject is strongly required. To this end, we conducted a cross-sectional study examining the type, frequency, severity, and predictors of anemia and its relationship with co-morbid conditions among institutionalized people with intellectual disability using blood profile tests conducted periodically at the facility. Methods Participants in the present study consisted of 315 people with intellectual disability (male: 197, average age 40.3 14.0; female: 118, average age 47.1 11.4), 90 people with cerebral palsy (male: 48, average age 42.1 10.7, female: 42, average age 43.0 11.8), 33 people with Down syndrome (male: 20, average age 42.1 9.5, female: 13, average age 47.5 6.1), and 39 people with severe motor and intellectual disabilities (male: 21, average age 38.5 10.6, female: 18, average age 35.2 9.9) from a population of 477 persons with intellectual disability (male: 286, average age 40.0 14.0; female: 191, average age 46.8 11.6) institutionalized at a public facility in Ibaraki prefecture (109 km north of Tokyo, with a population of approximately 3 million), Japan. As of 2001, a total of 12,600 people in Ibaraki prefecture were recognized as intellectually disabled. This public facility houses more severely disabled persons. Over 95% of the residents were judged as having a severe level of intellectual disability. The subjects in the present examination were not diagnosed according to the AAMR's criteria; however, upon admission to the facility, subjects were diagnosed according to criteria similar to that of the AAMR, namely, the criteria of intelligence quotient (IQ), activities of daily life (ADL) and adaptive skills. In Japan, periodical health checkups are provided for individuals in order to prevent lifestyle-related diseases including circulatory diseases. Recommended tests have been indicated for various health screenings. The present study retrospectively analyzed the existing health checkup data for each resident. The following information was collected at periodical health checkups administered in 2001: blood biochemical examinations, blood pressure, main disability, main diagnosis, IQs, and information regarding medications. The modified Binet Test for Japanese was used to calculate IQ at admission. According to the reference values of the institution, the definition of anemia was a hemoglobin (Hb) value 13.4 g/dl for males and 11.2 g/dl for females. Patterns of anemia were classified with mean cellular volume (MCV) and mean corpuscular hemoglobin concentration (MCHC). Characteristics of anemic (normocytic normochromic anemia and anemia except normocytic normochromic anemia) and non-anemic individuals were analyzed separately. Multiple regression and logistic regression analyses using anemia as a dependent variable and c-reactive protein (CRP) and the zinc sulfate turbidity test (ZTT) as indices of inflammation estimated the following predictors of anemia: sex, age, body mass index (BMI), and the use of anticonvulsants and/or major tranquilizers, minor tranq (...truncated)