参考資料 5 Young Blood Donation percentage, by country No Country % of Donatlons from donors under 18 years old % of Donatrons from donors ln age group 18lo 24 TOTAL % of Donatrons from oonors 5200o6 3700% 4684% 89.00% 80.17% Lao People's Democrattc Repubhc 1 DaOWe 3 Malawt 4 Jotswana 5 Vret Nam 000%仏 Repubhc of Korea burKIna卜 asO 2554% Gurnea 1100° Tuvalu 52696 JOrO a 000% Indra n nnq久 3abon Bhutan 3000/。 046% Mall Sao Tome and Pnncroe n lambodra 621% Myanmar _uxem0ourq ,4a ldrves T--l on 0009^ 00096 ３一４３３ 000,負 233°/。 Morocco 0000/。 lran (lslamtc ReDubhc on 76R9久 Tonga 085° Oemocratrc Republrc of the Conqo 00036 Unrted States of Amerrca Josnia and Hezeoovrna Я nQら久 /。 0009ム 908% 00096 00o% 峰 4929% 48.060/。 4691% bVン o 4329% 4055% 387436 38740/。 36000/。 3600° /。 3564% 35.290/。 3262% 3110% 3000° 30.000/。 2800% 28000/。 2394% 26.45% 2496% 25.81% 2597% 0しも ZZ 1373% 339° /。 2147% 1238% 1278% 21.45% 19.50% 1840°/。 1800% 1605% 18.00° /。 17.59% 17.58% 17.09% 1283% 1616% 1541% 1495% 000% 14830/。 000° 14170/。 0930/。 1262°/O 000,も 129296 /。 υυツЪ 21.32% 17030/O 16.21・ /。 16.16° /。 1564% 1495・ /。 14.830/。 1417% 14.00° /。 13.55° /。 1353% 13530/。 000% 1111% 1111% 000% 1096% 0009も 833% lahratn veroailan 4883% 4805% /。 000% lreland lceland Slovenra look lslands 55.22° /。 52.83% 000% iingapore Mauntrus Australta 5717% 56.34% 33.95% (VrgVzgla n 38 SOuth Af“ ca 39 Uzbekistan 5717% 4017% 35290/。 2■ [th望 18 Estonra Talrkrslan 59.00% 57.89° /。 29700/。 Poland r4aurrlanra 77.00% 7201% 6930% 6181% 376ら久 /。 Ki「 ibatl 1 77.320/。 2200% 5290/。 n under 25 years old VZツ o 11.11% 11.11% 11080/。 11 080/。 10960/. 090ツ b 89096 833° /。 ☆ Source Data repOrted by cOunines tO wHo Global Database on 31ood safety,2008(updated lo」 une 2010) 2009年度韓国における年齢別・職業別献血状況 2009年度献血事業統計 (韓国)より抜粋 ■ 年齢別 (単位 :人 ) 16∼ 19歳 20∼ 29歳 30∼ 39歳 40歳以上 l lll 80 60 総献血者数 2′ 5691954 40 20 80M7%} 男女女女男男 54932348248 875514261,110 286″ 451′ 176 女卿 197′ 男卿 40歳以上 ■ 職業別 (単位 :人 ) 総献m者数 : 2′ 569′ 954 60「一︱︱︱寸︱︲ 40 30 10 0 軍人 375477 会社員 470翻公務員 76275 自営業 ∞ 943 宗教職 6492 掛卿﹂薇・・事十ヽ・響一一 20 0 BL00D lloNoRS AND BL00o 00LLECTloN The aging populatiOn poses a g10bal challenge fOr b100d services /1た _メ ,Afα α びA′ ′ 0お αA夕 ′ 72θ 77,α ′ zグノたた αRα ム θ 77ビ 7Z 7ブ zノ BACKGROUND: The F t t s o m e a a rm n g ffiT n;:'.:,.nj.,,} j"_i " that are likely to be faced by transfusron serylces as populations conttnue to age STUDY DEStcN AND METHODS: Computerized data coilection was performed on all potentially transfused patients ln Finland, thus covering _70"/. of all blood usage. We srmulated the red blood cell (RBC) usage accordrng to the Finntsh sroups bur rne popurat susses j'ffi r orlffi::ffi :fl:fi lι 鳳 :鷺 Ll:号竃驚llHl:よ ing alc ttaК httOn prd“ ces ivat101l prOgranls in diffl_lrcnt CO111ltries by sirnply calclllatillg l)100d llsage per capita nlay be all illadcquate Or cvell rnisiea(ling practicc、 vllen trying tO plan fOr b100d scrvicc requirenlenis in aging populatio1ls_ MATERIALS AND METHoDS 1T", countries RESULTS: The Frnnrsh data demonstrate a markeo Increase rn RBC consumptron wtth increastng age among recipients, begrnnrng at around SO years:of age. The 70- to B0-year_olds have an eightfold higher RBC consumptron than 20_ to 40-year-olds. 11111:・ :ξ ::l主 ::》 :::γ IIilifillili:l:11111,li〕nly b100d stll〕 plier ill「 i1lland thus providi118 apprOxilnately 400,Ooo b10。 ci cOnlponcnts allnually tO tllc「 inllisll hOspltals.1｀ he data are cOnectcd lttI穏 CONCLUSioNS:A large palt Ofthe vanatiOn in RBc 出『蜘 l 軍鳳 :柵 1き基締 i(,1l oメ Hご〉 ISinkl,Filllan(li al〕 d Olllu data extracti01l systelll,Olllu,「 inlalld)The valida― use per caplta can be explained by the age distribution Of the different pOpulat10ns and nOt by the dlfferent tlol1 0f data has l)cell d()scribc(11)rcviOusIン natiOnal and reg10nal treatlllent pOlicles and protOcOls 1l cllrrelltly]o hOsl)ital distlicts prOvide data tO the leglstly AltOgetller used lf current effOlts are not enOu9h to selVe the changlng pOpulat10n dem。 zィ these hOspital dlstricts trallsfllse approxilnatcly 63ツ 9raphic and if increaslng 7096 0f b100d cOlnpOnellts produced ill「 dernands For b100d products cannot be met,there ls おtO illland.There are llo generai nat101lal transFtlsiOn guidelines in Finland need 10 cOnsider unprecedentOd measures such as 】躍:IT棋ュl窯1駄I:TII:1「 ‖ 器 reversing cellaln dOnor deferrals Or even expOlting 1導 bloOd from cOuntry tO countlγ 1営 1lli躍 : ふ 1部:1熙 ‖ 虻灘[熙猟 i島高温じよ n:ふ :よ『T鳶:l肌置:鍬 :f脂総l;T:∫ 認 1潔上町 dependcncy ranoに he nunlber Of`。 tiよ : 凝燎11甘 :鳳 ilぷ罵尊富犠:器 r謡 :計 Iご贅 l!駐群魁 till』 ti::」二 ∬ li:漁、量 t漁霊 T a cOde fOr tlle rnain procedllre);and 3)patients Ⅵ:ith hos_ pital、 isits M/ith any 11laligllant disordct allenlla Of any お13:ニツ:lalTll:マ輩∫ 猟軍 ilI糖ど写キ I Red Cross Blood Senlce, Kivihaantrc Z, 00310 Helsrnki, Finland; e- rnail: rnar;a-karsa [email protected] Received for publicarrcn August t0, 200g; revisiorr recen,etl September l l , 2iJ09, antl accepted Septetrlbcr I l. 2009. doi: t0.llt 111.1537-2995.2009 {}2.1:10 x 'ITTANSFUSION 20 t0;50 5[],1-588. 584 THANSFUSION Volume 50. March 2010 : cause,Obstetric disOrders,feta1 0r neonatal hen10rrhagic alld hemato10gic disOrders,and burns alld trauma(Inter_ na110nal classlncation()l Diseases IIcD-lo],main diag― nOSeS C81-C96,D45-D47,D50-D77,Ooo_o998,P50-P61, S00-S999,TOo― To7,T20-T32,T79_I・ 98,alnd z99 9)Patient data are enracted liOnl cxlsting electro11lc mcdical 純 :淋憮鰐lipl幾 AG:NC POPuLATiON AND BLOoD USAGE 狡ヨ鰤 J ] 2025 浣０︲鰈︲５０︲鰈＝二鰈２ ] 聰︱・鰈 Ψ 漑１％Ｉ・鑽主導︲孵・ｍ一 l' 螂 “ ” ¨ 珈］ “ ” ﹁ ¨ ¨ ］］ ∝ ” ﹁ｍ “ ¨］ ¨ ＯＣ ∞一Ｃ一﹂ＯＣ∞一ｏ上 ⊂“ＱＯ﹁ Fig' 1975 Examples of population pyramids for Finland, Ireland, and fapan for rlifferent age groups base4 on wHo statistics years l95o to 2000 and prognosis ior 2o25 to 2050' The left side of the pyramid indicates the proportion of males and the right side of females in the country. operations, test rcsults, and blood components as well as transfusions. F-or data security reasons, a coding on computer prograrn (DWcrypt, Datawell Oy, Espoo, Finland) encrypted parients' personal identiflcation numbers using different passworcls for each hospital dis_ trict. The data were analyzed with the analyzer reporting program (Ecomed, Datawell Oy) and a statistical sof'tware package (SPSS, SPSS, Inc., Chicago, IL). Ihe simulation analyses are based on red blood cell (RBC) Lrsage in Finland. Per-capita usage was calculated by dividing the annual RBC use of persons at certain age with the total number of living individuals of the same age. We simulated the RBC usage according to the Finnish practice on different age groups but the population demographics from other countries, which can be presented as popula_ tion p1-ramid, that is, distribution of different age groups within a population. Some examples of population pyramids for Finland, Ireland, and Japan are shb\^n in Fig. 1. For the population demographics, the data from Statistics Finland and \AIHO were used. The data for Finlancl consist of population statistics on the size and structure of the permanently resident population and related changes, such as births, deaths, marriages, migration, as well as population projections. For the otirer countries the IIIHO (United Nations, Department of Economic and Social Affairs, Population Division, http://www.un.org/esa/ population/unpop.htm) data consist of rvorld population prospects, popularlon by age groups, medium_fertility assumption based on UN population Division,s quin_ quennial estimates and proiections. RESULTS The Finnish data demonstrate a marked increase in RBC consumption with jncreasing age iimong recipienrs, beginning at aroutrd 50 years of agc. 'l-he elderly consis_ tently have a ntuch higher RBC consumption than younger people: 70- to B0-year-olds havc an eightfold higher RBC consunrlttion than 20- to 4O-year_olds (Fig. 2). Many othcr cotrntries show similar trends in RBC usage.2 a Accorcling to Corrncil of Europe 2004 statistics, the uSe prodtrcts varies considerably among the European Union ntenrber states (4-73 per 1000 inhabitants; mean, 37 per 1000 inhabitants).5 A large part of the variation in RBC use per capita can be explained by the age distribu_ of RLIC tion of the different populations and not by the clift.erent national and regional treatment policies and protocols used. Figure 3 shows the simulated RBC usage per capita 1950 to 2050, based on historicat and predicted age distribution figures (from the UN popu_ iation Division) and the age-distributed variation of blood usage (as RBC units) in Finland between 2002 and 2006. This simulation assurnes the same transfusion practices in selected countries in for each country- In Finland, SSTo of RBCs are used for patients treated for surgicai diagnoses or interventions, rvhereas 45o/o are used during conservative treatment periods. For the piatelets, the proportions are 32 and 68%, respectively. Of all blood used in Finland, 2LVo goes for treatment of hematologic malignancies (ICD-10 classes CB1-C97), 16% for trearment of cardiac and circulatory system diseases (i00-199), and l2yo for the treatment of tumors (C00-CB0 and D00-D4B). The popularion trend during tire period 1950 to 2050 predicts an increase in RBC requirements in most countries. Very few countries exhibit a period of decreasing need for simulated RBCs, and since 1990 the simulated RBC use shows increase in all thc cOuntries. We have calculated the blood-dependency ratio iu selected countries for the perioci 1950 to 2050, describing the number of age-noneligible clonors that each VOlume 50,March 2010 TRANSFUSioN 585 ALi ET AL. Red blood cell usage per 1000 rnhabrtants (units) %/rj&iiltrw:lde:FF*Frer3@@@a*:@81 &9_'-f,j4iEwrrs!-*::4!'i*,_it-rf, .a\a3k$fi 二ノ IWTFFTT翼躙 ――-2002-― _2003 町町 TTT,T葛 2004-― _20o5-― ―-20o6-― ― Fig.2.RBC usagc per capita by agc in Finland 20o2 to 2006.Current annud RBC usagcill「 mean マ鶏 T鳳「 inland is 50 11111ls per 1000 inhabitants_ age-eligible donor neecls to support in addition to hirn/ herseif (Fig. a). Most countries had a local maximum duringthe the 1990s. 1960s and lg70s and u.ufrruqr.n, aecline until In conclusion, rhc increasing proportion of elderly people in most counlries ivrll resr-Jt ln u _u1r. increase in *..O:TunO for RBC producrs globally, ,_,rri.r, ,r.urr.,.rr, modalities can be i the cOuntries analyzed in tllis study.HOv′ for death due tO ittury in FinlaI〕 cve■ the causes d are lnore Often cOn― nected tO tOxicity Or sllicida1 1)chavlor tllall traffic acci^ dents Or Othcr such inittries、 llCcessarン 16 vl)cre transfusiOns、 vO11ld l)e The Observed diFercnce Of 42%bet、ハeell thc 10■ 7est 「 (Ireland, 41 RBc units/10oo p01)ulatiOn)and highest ciependenceonRBC,:t'r"J:lr#5;.;""::".:T;"tt;,;X: (Japan, 58 RBc units/10oo pOpulatiOn)cOuntry in tllis argue rhar future elderly populations w;lt be healthier than their current counterparts. However, the Finnish data have not shoi.m a decrease in tfr" t.uniillsion needs of elderly people. For the prevalence of ttru diseases treated rvith transfusions, we silllulat10n is ft11ly explained by the direrent llatiOnal cornpared \AtlO ciata on mortaiity and morbidity (http:/itvwr,gwho.intlr,r,trosisl whostat/2009/en/index.html). For .o.aiouur.uto. Oir_ eases, which is rhe secondl*r:r1 cliagnostic g.u.,p u,oong transfused patienrs in Finland, the cluntriel selected for the sinruiation analyses have similar ug"_r,u.rOu.Ot.a mortaiity rates. TWo exceptions ar" RusJja and poland, w}rere trre rnortarity rates for carciiovascular a,r."r". *, three- and rwofold compared with Finland (Table 1). The age-standardized mortaliry rate for injuries is 64 per 100'000 popuration in Fiarand, trrus hrgher ihan most of 586 TRANSFUSTON Volume 50, March 2010 pOpulatiOn pyrantid ltis clcar that althOugh tlle natiOnal data On RBC use are a usefulindicatOr,they are l10t suFl― clent tO conlpare transfusiOn practice an10ng cOulltries 輝搬鮮搬 1樅 II群榊 the pOpulatiOn eligiblc tO donate bloOd lll deve10ped W:≒ 繁」幌器 mT∫ r糧織 it質 1∬ increases expectcd in Eastern Europe an(l dcvcloped countries ぴn胞思 :Ti篤 1宅 ITF[1謝 lb:認 Ⅷr∬ sLlppOrt in additiOn tO hilll_Or herselt shows tlDatin lnost AG:NG POPULAT:ON AND BL00D USAGE 。６ Canada ５５ France 。５ * Ireland Italy ５４ Poland 。４ Russran Federatlon ''.* Sparn ５３︵∽〓こう︶ ∽脚Ｃｏコ一ｎｏｒｃ一〇〇〇ＨＬＯＱＯＯЮ∽⊃ 一 ∪ “につ０コ０一ＯωＬ∝ ５６ Austraha ,ry -- unlted Klngdom z-T unrted states 1960 1965 19701975 1980 1985 1990 19952000200520102015202020252030203520402o452050 Fig. 3. Simulation of clinical use of RBC units per 1000 population (based on age-distributed variation in bl'od usage [as RBC unitsl in Finland befiveen 2OO2and2OO6l. Austra lta -Canada Fra n ce Germany --*-Ireland _* Ita ty --Ja pa n Po la nd Federatron -Russtan -qnain Kingdom -United states --unrted Finland 19501955196019651970 19751980198519901995200o2005 2010201520202025203020352040 20452050 Fig. 4- Blood-dependency ratio donors in the population. in selected countries I 950 to 2o50: ratio of age-eligible (l 8-65 years) to age-noneligible blood Volume 50, March 2010 TRANSFUSION 587 AL:ET AL 39 countrjes a local maximum was exccedecl clrrring the 1960s REFERENCES and i97t)s and a sultsequent decline untrl the 1990s suggests thal the .".ruitrr..r_rt of rionors has lteen easicr-iom yeirr to year than cluring a period of corrstant ratio. For the future, ttrese prolcctioii, .lrn* an rncreasing Ihis j. trend for tl-re bloocl-dcpendenclr ratio, suggesting that it be more dilficulr to recruir UtooO annnlir, exacerbatecl by thc fact that recruitment levcls have been rclarively will good in recent years r\Jth'ugh recruitrnent of bloocl donors rnay appear to have bee"n relativeiy anrl high jn recent years, historicaily this has not tr,ri,.,"ury tt," case and it is unlikely to be so in the future u, ,r,ur, local blood scrvices rvrll attest_ Ihe eligible clonor population is lirnrted and radical ar:l ions to address tfr,r, .u.f, as extend_ ing the age lirnits for donation, nloy nor_ io becornc a realiry in sorne countries. Already i., ti. Un,t"a Kingdorn, Australia, and some US states, the upper og" ,,rn,, of ,O years tirr not accepting blood fronr Lnstin! donors has been removed_ Also e,rtension of the age lirnit to l,ounge"r 17 years-has been i'rprenrented i' ,n-" aJno. centers in l)enmark, the United Kir.rgtiom, and the United StatesIf current efforts to maintain effectrve natronal blood services are not enough to serve the changing population dernographrc ancl if increasing demand, 2. Ilcguil C, Closon MC, Vanriekercklove triltlon ol transfusior icrv 3. use 4. to the rnanuscnpt submittecl to TRANSFUSION. 588 TRANSFUsloN vOlume 50,March 201o e n rs. no " r y., i,, #'::il;1,:'^-,,T tI[H,:io 277 _ 27 K, Ilurwcn DR. Blood bf inpatrent erderll,pr.r'uratron rn thc {Initcd Transfusron 2007 ;47. 582 _92. .States. 6- tlte collectton, testrr.rg and use of bloocl and blood compo nents ln Ertrope rn 2004 fdocunlent on the InternetJ. Strasbourg. Council of Europe publishing; 2007 lcired clred 2009 Aug il. Avarlable frorn: IJIIL: http /i wr,nveciqrn.eu/ rnedras/fichiersiNEW_2004 Report _on the_.pdf Stalisrical yearbook of Frnland llorkent-llat.etr B. Report on 200.1. p. 674. .sratrstrcs Frnland. ldocuntenr on the Internet]. Icited 2009 Aug Avarlable frorn. URL.http.//pnveb2 stat fi/ hc'alth care nc.e<i. The au*rors declare that they have no conflrct-s of interest rel_ L.vant r i 5 to country, to nleet what is no\v an establisl.recl ancl irnpera_ trve CONFLTCT OF INTEREST a p, Baele p. Concen- Weils,{W, MoLrntcr pJ, Chapnr,rn CE, Stainsbl, D, \4rallis Jp \ilhere does hlooci goz l)rosl)L_Lttvc observatronal stutiy of red cell transfusron rn north Englantl IlMl 2002;1125:g03 Van der poel C, Ianssen I\{p, ioritoo,i pro,l, edented nleasures. It m p trent database. Tr ansfusr on 2O0i., 17. Andersorr SA, \,lenls NI, O,Corrnt,ll pa ucts cannot be met, we may neeci to consider unprec_ crererrars,suchasr;"Xll::Xfi ,',""',,:':':,ffi:?n:ilil collntrles, or even exporting bloocl fronr country Palo ll, Ali-lr,lelkl.rla T, IIanhr_la Il, Iinttr V, Krusrus I, Lep_ irdnen E, l\{ahlarnaki EK, pcrlrorue.nti V, Iiajanraki A, Rautoncrr J, Salrncnpcra M, Salo li, Salrnen I, Savolauten ER, .Sjr;va)l S, Surstcrrna.r I\,1, Sg-1ila M, Tirnfraar.r A, Vah.imurto M, i\,Iakr T. l)evcloltnrt,nt of pernranerrt naf ion:il register of blood cornponcnt lrsc uttirzrng clt,cttonrc hospital inforlltatlon s),sfenls. Vox Sang 200{);91:1,10 7. 7 il. s ahkoiset_;trlka rs u t /!,LloslLrrja2004_suppea / b tml / .;riJkarsu.pdf LI S. Census Bureau Clobal population contpositron ldocument on the Internetl. \{ras}rrngton, DC. tJ.S Depart_ ment of Commerce; 2002. p. 49_53. fcited 2009 Aug ]1. Available fronr: UIiL. hl census' gov/ prod/ " "t'\'vw 300.1 pubs /np,or. par. ff "