Department of Transfusion Medicine, Shaanxi Provincial People's Hospital, Xi'an, China.
Department of Epidemiology and Biostatistics, The Second Affiliated Hospital of Chongqing Medical University, Chong Qing, China.
JMIR Public Health Surveill. 2024 Feb 22;10:e48617. doi: 10.2196/48617.
The World Health Organization emphasizes the importance of completely voluntary blood donation to maintain safe and sustainable blood supplies. However, the benefits of blood donation for donors, such as reducing the risk of disease, remain a topic of debate due to the existence of the healthy donor effect (HDE). This effect arises because of inherent health differences between blood donors and the general population, and it is also considered a methodological issue.
This study aims to generate a more detailed health profile of blood donors from a donor cohort study to mitigate and quantify the HDE and properly interpret the association between blood donation and disease outcomes among blood donors.
A retrospective cohort study was conducted between January 2012 and December 2018 among donors before their first donation. One-to-one propensity score matching was conducted through a random selection of individuals without any history of blood donation, as reported from their electronic health records. We conducted a Poisson regression between blood donors and non-blood donors before the first donation to estimate the adjusted incidence rate ratio (AIRR) of selected blood donation-related diseases, as defined by 13 categories of International Classification of Diseases, Tenth Revision (ICD-10) codes.
Of the 0.6 million blood donors, 15,115 had an inpatient record before their first donation, whereas 17,356 non-blood donors had an inpatient record. For the comparison between blood donors and the matched non-blood donors, the HDE (the disease incidence rate ratio between non-blood donors and blood donors) was an AIRR of 1.152 (95% CI 1.127-1.178; P<.001). Among disease categories not recommended for blood donation in China, the strongest HDE was observed in the ICD-10 D50-D89 codes, which pertain to diseases of the blood and blood-forming organs as well as certain disorders involving the immune mechanism (AIRR 3.225, 95% CI 2.402-4.330; P<.001). After age stratification, we found that people who had their first blood donation between 46-55 years old had the strongest HDE (AIRR 1.816, 95% CI 1.707-1.932; P<.001). Both male and female donors had significant HDE (AIRR 1.082, 95% CI 1.05-1.116; P=.003; and AIRR 1.236, 95% CI 1.196-1.277; P<.001, respectively) compared with matched non-blood donors.
: Our research findings suggest that the HDE is present among blood donors, particularly among female donors and those who first donated blood between the ages of 46 and 55 years.
Chinese Clinical Trial Registry ChiCTR2200055983; https://www.chictr.org.cn/showproj.html?proj=51760.
世界卫生组织强调完全自愿献血对于维持安全和可持续的血液供应的重要性。然而，由于健康献血者效应（HDE）的存在，献血对献血者的益处，例如降低患病风险，仍然是一个有争议的话题。这种效应源于献血者与一般人群之间固有的健康差异，也被认为是一个方法学问题。
本研究旨在通过对献血者队列研究生成更详细的献血者健康概况，以减轻和量化 HDE，并正确解释献血与献血者疾病结局之间的关联。
在 2012 年 1 月至 2018 年 12 月期间，对首次献血前的献血者进行了一项回顾性队列研究。通过从电子健康记录中随机选择没有献血史的个体进行一对一倾向评分匹配。我们在首次献血前对献血者和非献血者进行了泊松回归，以估计按 13 类国际疾病分类，第十版（ICD-10）代码定义的与献血相关疾病的调整发病率比（AIRR）。
在 60 万名献血者中，有 15115 人在首次献血前有住院记录，而 17356 名非献血者有住院记录。在献血者与匹配的非献血者之间的比较中，HDE（非献血者与献血者之间的疾病发病率比）为 1.152（95%CI 1.127-1.178；P<.001）。在中国不推荐献血的疾病类别中，观察到最强的 HDE 是 ICD-10 D50-D89 代码，涉及血液和造血器官疾病以及某些涉及免疫机制的疾病（AIRR 3.225，95%CI 2.402-4.330；P<.001）。在年龄分层后，我们发现 46-55 岁之间首次献血的人具有最强的 HDE（AIRR 1.816，95%CI 1.707-1.932；P<.001）。与匹配的非献血者相比，男性和女性献血者均具有显著的 HDE（AIRR 1.082，95%CI 1.05-1.116；P=.003；和 AIRR 1.236，95%CI 1.196-1.277；P<.001）。
我们的研究结果表明，HDE 存在于献血者中，特别是女性献血者和首次献血年龄在 46-55 岁之间的献血者中。
中国临床试验注册中心 ChiCTR2200055983；https://www.chictr.org.cn/showproj.html?proj=51760。
