Urban versus rural blood donors in the United States and the relationship with transfusion-transmissible infections

Abstract

Introduction: Most US blood donations are from donors living in urban areas. Demographics and infectious disease prevalence may vary in urban versus rural areas. We assessed demographic and transfusion-transmissible infection (TTI) prevalence among donors living in urban versus rural areas.

Methods: Blood donation data from the Transfusion-Transmissible Infections Monitoring System were categorized as urban or rural based on donor residential zip code for a three-year period (October 2020-September 2023). Demographics and TTI prevalence (HBV, HCV, HIV consensus positive (CP) and recent infection (RI), and syphilis CP and active infection (ASI)) were compared between the two geographies. Regression analysis determined the odds of TTIs among donors while controlling for demographic characteristics.

Results: From 21,941,910 donations, 83.9% were categorized as urban and 16.1% as rural. Donations from urban versus rural donors were more likely to be from men, between the ages of 25 and 54, non-White, and first-time. HBV CP, HIV CP, syphilis CP, and ASI were more prevalent in donations from urban versus rural donors. Significantly higher seroconversion rates also occurred in donors with syphilis CP and ASI. When adjusting for differences in donor demographics and characteristics, only prevalence in HBV CP remained more likely to occur among urban donors (odds ratio (OR): 1.28, 95% CI: 1.03, 1.6) and HCV CP less likely to occur among urban donors (OR: 0.8, 95% CI: 0.71, 0.9).

Discussion: Blood donor demographics and TTI prevalence differ in urban areas compared to rural; however, the differences in demographics may explain some of the TTI prevalence trends.

Keywords: rural health; transfusion‐transmitted infections; urban health.