Boom or bust? Estimating blood demand and supply as the baby boomers age

O n January 1, 2011, the first-born of the baby boomer generation celebrated their 65th birthday. The social and economic impact caused by the aging and retirement of those born between 1946 and 1964 has long been debated and is now upon us. For the blood banking industry in the United States, little has been discussed publicly with even less preparation for the coming changes. US blood centers appear oblivious to the possible effect of shifting demographics and are poorly prepared to forecast long-term blood demands, raising the specter of future blood shortages even as the industry wallows presently in an apparent glut of blood. While the National Blood Collection and Utilization Survey (NBCUS) has proven a powerful tool to track blood donation, and the US Census Bureau has mapped and predicted the effects of demographic changes well into the future, inadequate information on the demographics of blood use in our hospitals and those factors that influence utilization has left us without the tools we need to inform policy. In this setting, the report of Greinacher and coworkers sounds a warning bell. In the small German federal state of Mecklenburg-Pomerania with a population of 1,707,266 inhabitants, the authors were able to track the vast majority of hospital transfusions and blood bank donation records for a 1-year period (2005). These were used to integrate ageand gender-specific transfusion rates with well-established population demographics to predict the influence of population changes on the relative blood supply. The process was validated by utilizing 1997 transfusion data from one hospital to predict blood demand and supply in 2007. Remarkable accuracy was demonstrated, with a difference of only 226 red blood cell (RBC) units (1.2%) from that actually used. In this former East German state, marked population changes followed the fall of the Berlin Wall and are predicted to continue into the future. Birth rates have fallen precipitously and young people often migrate elsewhere to follow financial opportunities, while the postwar generation ages and is expected to live longer than their parents. Overall the population is predicted to decline by 8.3% by 2020, but disproportionately: the potential blood donor group aged 18 to 68 years may decline by 16.1% while the patient group 65 years and older that received approximately 62.1% of RBC transfusions in 2005 is predicted to grow by 26.4%. Assuming no changes in donation patterns and medical indications for blood use, these opposing forces are predicted to yield a 47% shortfall in the blood supply by 2020, representing a major challenge to blood providers and their hospital users. This study has weaknesses: Age-specific blood use was estimated using data from major hospitals that represent only 80.5% of distributed products. It is possible, but unlikely, that transfusions occurring outside the hospital environment would show differing demographics. It is also based on only a single year of data, which may be subject to peculiarities. Finally, a study of this nature cannot account for new technologies, blood management strategies, or world events (e.g., global recession) that may affect supply and demand. Nevertheless, it is clear that population demographics provide a powerful baseline on which to build future plans for the blood supply and that the need for such planning is critical. Other countries show similar population dynamics to those described in Germany. Indeed a number of major economies, including Japan, Hong Kong, South Korea, Italy, Spain, and many other European countries have inverted population pyramids that bode poorly for the future blood supply, with dramatically increasing aged groups and diminishing young donor pools. Interventions to increase the blood supply and decrease blood utilization are needed sooner rather than later. How do these data reflect the US situation? Population demographic predictions are readily available, calculated from the 2000 census that will soon be updated with 2010 data. The threat is real: the US population is expected to swell by approximately 10% over the next 10 years; however, the major donor population (aged 16-64) will increase by only 5.2%, while those 65 years and older will increase 36.2% from 40.2 million to 54.8 million. The 65 years and older age group will shift from 13.0 to 16.1% of the total population, an absolute 3.1% increase, dramatic indeed if this group uses the majority of the blood supply (Fig. 1). Unfortunately, little US age-specific blood use data are available. Early work performed in a limited setting in Olmsted County, Minnesota, in 1989 through 1992, suggested that 53.3% of RBC units were transfused into patients older than 65 years at a time when the incident rates of RBC transfusion were approximately 48.7 units/1000 inhabitants. The findings of Greinacher and colleagues that 62.1% of RBC were transfused into this TRANSFUSION 2011;51:670-673.