Guangzhou Blood Center, 31 Lu Yuan Road, Guangzhou, Guangdong, China.
Clinical and Translational Sciences Institute (CTSI), Michigan State University, 909 Wilson Road Suite B500, East Lansing, MI, 48824, USA.
BMC Public Health. 2021 Apr 29;21(1):819. doi: 10.1186/s12889-021-10819-4.
A nationwide ban on family/replacement donation (FRD) went into effect on April 1, 2018 in China. To date, no reports relevant to the trend of plateletpheresis donations before and after a nationwide ban on FRD were found.
We used two independent full samples, consisting of 135,851 and 82,129 plateletpheresis donors from Guangzhou and Chengdu between October 2012 and September 2019, respectively. A pseudo-panel data approach was applied by grouping three time-invariant covariates - gender, blood donation history, and birth year across 14 cross-sections (a 6-month interval each) to form a total of 24 cohort groups (14 × 24 = 336 cohorts, i.e., cells) with each having common covariates. The outcome was average apheresis platelet units per donor in each cell. We performed a two-piecewise linear mixed model with the cross-section (i.e., time) just right before the ban as a time breakpoint (i.e., 11th cross-section) to examine the trend of outcome with the adjustment of three time-invariant covariates. We removed the FRDs in each of the first 11 cross-sections to detect its possible influence on the trend.
The final model for the samples from Guangzhou presented a two-piecewise linear trend of the outcome over time with a horizontal line to the left of the breakpoint (β = 0.0111, p = 0.0976) and a significantly positive linear trend to the right (β = 0.0404, p < 0.0001). The male donors and the donors with plateletpheresis donation history had an increased baseline outcome and a significant outcome change over time after the ban. Such a two-piecewise linear trend pattern can be replicated using the samples from Chengdu with some minor variations. Removing the FRD before the ban can change the pattern.
The significant increase of the average apheresis platelet units per donor over time after the FRD ban may be related to the implement of the FRD ban and the improved donation behavior of male donors and/or donors with platelet donation history after the ban. Our findings may potentially motivate the policymakers in other countries where the FRD for plateletpheresis donation is still legitimate to phase out their FRD strategy and ultimately achieve 100% voluntary plateletpheresis donation.
2018 年 4 月 1 日起，中国全面禁止家庭/替代供者捐献（FRD）。截至目前，尚未有关于全国范围内 FRD 禁令前后血小板单采捐献趋势的报告。
我们使用了两个独立的全样本，分别由 2012 年 10 月至 2019 年 9 月间来自广州和成都的 135851 名和 82129 名血小板单采供者组成。通过将三个时间不变协变量（性别、献血史和出生年份）按 14 个时间区间（每个区间 6 个月）分组，形成总共 24 个队列组（14×24=336 个队列，即细胞），每个队列组具有共同的协变量。结果为每个细胞中每位供者的平均单采血小板单位数。我们采用两段线性混合模型，以禁令前的时间区间（即第 11 个时间区间）作为时间分割点，调整三个时间不变协变量，检查结果的趋势。我们在每个前 11 个时间区间去除 FRD，以检测其对趋势的可能影响。
来自广州的样本的最终模型呈现出一个随时间的两段线性趋势，在分割点的左侧有一条水平线（β=0.0111，p=0.0976），右侧有一个显著的正线性趋势（β=0.0404，p<0.0001）。男性供者和有血小板单采捐献史的供者在禁令后基线结果增加，且随时间有显著的变化。这种两段线性趋势模式可以使用成都的样本复制，略有变化。在禁令前去除 FRD 可以改变模式。
FRD 禁令后，每位供者的平均单采血小板单位数随时间显著增加，这可能与 FRD 禁令的实施以及禁令后男性供者和/或有血小板捐献史的供者的捐献行为改善有关。我们的发现可能会促使其他国家的决策者逐步淘汰他们的 FRD 策略，并最终实现 100%自愿的血小板单采捐献。
