Monitoring viral incidence rates: tools for the implementation of European Union regulations

BACKGROUND AND OBJECTIVES: European legislation requires manufacturers of plasma products to report epidemiological data on human immunodeficiency virus, hepatitis B virus and hepatitis C virus in donor populations. The incidence rates of such infections are directly related to the risk of infection transmission. We propose two statistical tests to evaluate these incidence rates. MATERIALS AND METHODS: Infection data of the four Dutch blood collection centres from 2003 through 2006 were analysed. For transversal comparison of centres and detection of increased incidence rates, a new statistical test was developed (outlier test). For longitudinal detection of trends in incidence rates, a generic test for trend is proposed. The power and risk of non-detection are evaluated for both tests. RESULTS: Application of the outlier test did not reveal any significantly increased incidence rates among centres in The Netherlands. The test for trend showed no significant increase in incidence rates in individual centres, but on national level a statistically significant increase in hepatitis C virus incidence was observed (P-value of 0.01). CONCLUSION: The proposed tests allow signalling of outlier centres and trends in incidence rates both at individual centre and at national levels. Graphical support and the use of as much relevant historical data as possible is recommended. The statistical tests described are generic and can be applied by any blood establishment and plasma fractionation institut

The PROTON study: profiles of blood product transfusion recipients in the Netherlands

Background Transfusion recipient data are needed for correct estimation of cost-effectiveness in terms of recipient outcomes after transfusion. Also, such data are essential for monitoring blood use, estimation of future blood use and benchmarking. Study Design and Methods A sample of 20 of 93 Dutch hospitals was selected. Datasets containing all blood product transfusions between 1996 and 2006 were extracted from hospital blood bank computer systems, containing transfusion date, blood product type and recipient characteristics such as gender, address, date of birth. The datasets were appended and matched to national hospitalization datasets including primary discharge diagnoses (ICD-9). Using these data, we estimated distributions of blood recipient characteristics in the Netherlands. Results The dataset contains information on 290 043 patients who received 2 405 012 blood products (1 720 075 RBC, 443 697 FFP, 241 240 PLT) from 1996 to 2006. This is 28% of total blood use in the Netherlands during this period. Comparable diagnosis and age distributions of all hospitalizations indicate included hospitals to be representative, per hospital category, for the Netherlands. Of all red blood cells (RBC), fresh-frozen plasma (FFP) and platelets (PLT), respectively 1 center dot 7%, 2 center dot 5% and 4 center dot 5% were transfused to neonates. Recipients of 65 years or older received 57 center dot 6% of RBC, 41 center dot 4% of FFP and 29 center dot 0% of PLT. Most of the blood products were transfused to patients with diseases of the circulary system (25 center dot 1%) or neoplasms (22 center dot 0%). Conclusion Transfusion data from a limited sample of hospitals can be used to estimate national distributions of blood recipient characteristics

Depression increases the onset of cardiovascular disease over and above other determinants in older primary care patients, a cohort study

BACKGROUND: To determine if major depressive disorder (MDD) in older primary care patients is an independent risk factor for cardiovascular events.METHODS: A cohort of 143 primary care patients with depression and 139 non-depressed controls without depression (both aged over 55??years, matched for age and gender) from the Netherlands was evaluated for 2??years. MDD was diagnosed according to DSM-IV-criteria. During the follow-up period, information was collected on physical health, depression status and behavioural risk factors. CVD end points were assessed with validated annual questionnaires and were crosschecked with medical records.RESULTS: Thirty-four participants experienced a cardiovascular event, of which 71??{\%} were depressed: 27/134 with MDD (20.1??{\%}) and 9/137 controls (6.6??{\%}). MDD was associated with a hazard ratio of 2.83 (p value 0,004, 95??{\%} CI 1.32 to 6.05) for cardiovascular events. After adjustment for cardiovascular medication, the hazard ratio was 2.46 (95??{\%} CI 1.14 to 5.30).CONCLUSIONS: In a 2??year follow-up period, baseline MDD increased the risk for CVD in older primary care patients compared with controls, over and above well-known cardiovascular risk factors