Current Status, Risk Factors, and Altitude Correction Controversies of Childhood Anemia on the Qinghai-Xizang Plateau

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Background: The hypoxic environment at high altitudes induces physiological polycythemia, complicating the diagnosis of childhood anemia. The prevalence of anemia among children on the Qinghai-Xizang Plateau remains persistently high, representing a major public health challenge. Objective: This review synthesizes recent field studies from Xizang, Qinghai, and the western Sichuan Plateau to systematically describe the epidemiological characteristics, major risk factors, and controversies surrounding altitude correction formulas for anemia in children aged 0 - 6 years on the Qinghai-Xizang Plateau. Studies involving slightly older children (e.g., 3 - 7 years, schoolchildren) or hospitalized populations are included as supplementary evidence where data for the target age group are limited. Methods: We conducted a comprehensive narrative review of cross-sectional surveys, systematic reviews, and multivariable logistic regression analyses published in Chinese and international peer-reviewed journals up to 2025. Results: Depending on the altitude correction formula applied, the prevalence of anemia ranges from 30% to 85% at altitudes above 2500 m, reaching 65% to 85% above 4000 m. Major risk factors include altitude ≥ 4000 m, residence in agricultural or pastoral areas, monotonous complementary feeding, consumption of butter tea, and maternal anemia. The current WHO/CDC altitude correction formulas significantly overestimate anemia prevalence in Xizang’s children, and locally derived correction values from Chinese studies are only 30% - 50% of the international standards. Conclusions: Anemia diagnosis in children on the Qinghai-Xizang Plateau requires locally appropriate standards. Intervention strategies should be precisely tailored to high-altitude physiological adaptations, dietary patterns, and feeding practices.

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