Increased prevalence of anemia among recently immigrated female South Asian college students: A cross-sectional study from three primary care clinics in a college town Free

Background: Anemia is a major health concern among women of reproductive age, particularly in South Asia, where nutritional deficiencies and heavy menstrual bleeding are prevalent. Female students recently immigrated from South Asian countries to the U.S. may face additional risk factors, including dietary changes, limited access to healthcare, and cultural barriers to care. Data on anemia prevalence in this subgroup within U.S. college towns are limited.

Methods: A retrospective cross-sectional review of electronic medical records from three primary care clinics serving a large Midwestern university was conducted. Inclusion criteria were: female sex, age 18–26 years, and at least one complete blood count (CBC) performed between January 2023 and May 2024. Immigration status was determined from intake questionnaires; “recently immigrated” was defined as arrival in the U.S. within the past 3 years. South Asian origin was defined as birth in India, Pakistan, Bangladesh, Nepal, Sri Lanka, Bhutan, or the Maldives. Anemia was defined per WHO criteria (hemoglobin <12 g/dL). Anemia prevalence was compared between recently immigrated female South Asian students and U.S.-born female students using chi-square testing.

Results: A total of 512 female students met inclusion criteria: 41 recently immigrated from South Asia (8.0% of total; mean age 20.2 ± 1.5 years) and 471 U.S.-born (mean age 20.6 ± 1.8 years). Anemia prevalence was significantly higher in the immigrant group compared to U.S.-born students (41.5% vs 11.1%, p<0.001). Microcytic anemia accounted for 82% of cases among immigrant students, with normocytic anemia comprising the remainder. Only 37% of anemic immigrant students underwent iron studies or further etiologic workup within 3 months of diagnosis.Conclusions: Recently immigrated female South Asian college students, although they comprised only 8% of the student population seen at three primary care clinics, exhibited nearly a fourfold higher prevalence of anemia compared to U.S.-born female peers. They were also less likely to receive timely diagnostic evaluation. These findings underscore the need for targeted screening protocols and proactive anemia workup at the primary care level for this high-risk population. Integrating culturally tailored nutrition counseling and early laboratory testing during initial visits could improve detection and management of anemia among South Asian female students.