Hierarchical analysis of anaemia deferral in blood donor candidates: the individual in the population perspective.

BACKGROUND AND OBJECTIVES: Deferral due to anaemia is common in blood donor selection, mainly owing to iron deficiency. This study analysed the prevalence of anaemia, its individual and group-associated factors in 335,095 blood donor candidates in the Hemominas Foundation, a public blood centre in Minas Gerais State, Brazil. MATERIALS AND METHODS: For the hierarchical analysis, gender, self-reported skin colour and age were included as independent variables at the individual level. Second level variables included proportion of self-reported white, male proportion, prevalence of sickle cell trait and Human Development Index (HDI) for the cities where the blood centres were located. RESULTS: Deferral due to anaemia was 9.71% in the donor population in the present study. Differences among geographic areas throughout the State were observed; living in an area with lower HDI (P < 0.032), female gender and non-white skin colour (both P < 0.001) were significantly associated with anaemia. Cities with a lower HDI had higher prevalence rates of anaemia when compared with the others. Anaemia was more pronounced among female and non-white donors and in the northern part of the State. CONCLUSION: A high deferral of blood donors due to anaemia, mostly associated with poverty was observed and deserves attention from the public health perspective. Blood centres should consider the profile of donors and their geographic location when planning mobile blood collection or regional campaigns.

Household context and self-rated health: the effect of unemployment and informal work.

OBJECTIVE: This article investigates whether the presence of residents in precarious work situations influences the self-rated health of people living in the same household. METHODS: The study is based on the National Household Survey (PNAD) carried out in 1998 (n = 85,384) and 2003 (n = 89,063) by the Brazilian Institute of Geography and Statistics. These samples included all individuals aged 15 years and over, who lived in large metropolitan regions of Brazil. The effects at individual and household levels were estimated by the generalised estimation equations (GEE). RESULTS: At the individual level, poor self-rated health was inversely associated with schooling and positively associated with female sex, older age, informal work, unemployment and not economically active. Living in households with at least one informal or unemployed worker was positively associated with poor self-rated health, regardless of individual factors and socioeconomic characteristics of the household in 1998 (informal work: OR 1.09; 95% CI 1.06 to 1.12; unemployment: OR 1.08; 95% CI 1.04 to 1.13), and in 2003 (informal work: OR 1.06; 95% CI 1.03 to 1.10; unemployment: OR 1.10; 95% CI 1.05 to 1.15). CONCLUSION: These results suggest that unemployment and/or informal work have a contextual impact on the self-rated health of household dwellers. They add to the hypothesis that adverse conditions in the labour market and their impact on the health of individuals and groups are relevant in understanding inequalities in health.