Population-Based Analysis of the Impact of Demographics on the Current and Future Blood Supply in the Saarland

Abstract

Background: The federal state of Saarland (SL) is experiencing the fastest demographic change in the western part of Germany. In this study, we analyzed retrospective data on the current and future supply of red blood cell concentrates (RBC) in this region and compared it to the current and future RBC demand in SL hospitals.

Methods: The projection of the SL blood supply in 2030 was modeled based on SL demographics for age distribution and donation frequency of donors, and the RBC transfusion data for in-house patients. These results were compared to published data on the transfusion demand from the state of Mecklenburg-Western Pomerania (MV).

Results: For the period January 1 to December 31, 2017, a total of 43,205 whole blood donations were collected. The donation frequency in SL never exceeded 80 per 1,000 inhabitants and was well below the numbers in MV. Thirty-one percent of the donors were responsible for 53.5% of the donations, and donors older than 45 years of age contributed highly to the total blood supply. In addition, 40,614 RBC transfusions at 10 SL hospitals were analyzed representing nearly all RBC transfusions for in-house patients in this region. RBC transfusions per 1,000 inhabitants increased with age from 24 (50-54) to 140 (80-84) years. Facing an already existing structural deficit of nearly 8,200 RBC in 2017, the projection predicts a dramatic increase in the regional deficit to >18,300 RBC in 2030.

Conclusion: Our results on RBC demand in SL are comparable but not identical to those projected for the region of MV in eastern Germany. Due to the ongoing demographic changes in Germany as a whole, regular regional monitoring of RBC demand and the age structure of blood recipients and donors should be implemented to allow for better strategic planning in blood transfusion services and hospitals.

Keywords: Blood supply; Demographic change; Red blood cell units.

Fig. 1

Relative numbers of WBD per age group per 1,000 inhabitants, SL (2017) versus MV (2015) [9]. The WBD per age group in SL never exceeded 80 per 1,000 inhabitants. This was, therefore, well below the numbers observed in MV with a peak of 180 per 1,000 for the age group 20–24 years.

Fig. 2

Frequency of WBD per age group. For each age group, the percentage of donors with the following WBD frequencies in 2017 is given: dark blue: 1 WBD; red: 2 WBD; green: 3 WBD; purple: 4 WBD; light blue: 5 WBD; orange: 6 WBD.

Fig. 3

Absolute number of WBD per age group in SL for 2017, and projection for 2030. The age groups over 45 years highly contributed to the total supply. Regarding the SL demographics and assuming the donation frequency of 2017 for the future, the projection for 2030 predicts a significant drop of WBD in response to the decreasing number of donors in the 45- to 65-year age cohort.

Fig. 4

Absolute number of transfused RBC in SL in 2017 (n = 40,614) per age group, and projection of the future absolute RBC demand in 2030. The constant increase of RBC transfusions starts with age cohort 45–49 years. The drop in the age group 65–74 years corresponds to the low birth rate cohorts of World War II and the post-war period. This lower number of inhabitants leads to the current decrease in the absolute RBC demand. In 2030, the baby-boomer generation will cause a sharp increase in the transfusion demand in this age group.

Fig. 5

Relative number of transfused RB due to patient classification per age group per 1,000 inhabitants. Patient classification: surgical, medical, ICU, pediatric, or not classified according to the ward at which the patient was treated. The numbers increased from <20 for age group 40–45 years to 140 for the cohorts >80 years. The distribution of treatment classifications was quite stable among all adult age groups, indicating no major change in the treatment quality or intensity in older compared to younger patients.

Fig. 6

Relative RBC demand per age group in SL 2017 compared to MV 2015 [12]. The relative numbers of transfused RBC per 1,000 inhabitants were lower in SL compared to MV in the age groups >40 years, indicating a more restrictive transfusion regime. This was even more pronounced for age groups >70 years.

Fig. 7

Current supply situation in SL 2017, and projection of the total blood supply in 2030. Projection of the SL blood supply in 2030 based on the SL demographics, the 2017 age distribution and donation frequency data for WBD donors, and the RBC transfusion data for in-house patients and out-patients plus discarded RBC. From the current structural deficit of nearly 8,200 RBC in 2017, the projection predicts a dramatic increase in the regional deficit to >18,300 RBC in 2030.