The determinants of blood donation in France. María Errea (UPNA) Nicolas Sirven (IRDES, Université Paris Descartes) Thierry Rochereau (IRDES, LIRAES)

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1 The determinants of blood donation in France María Errea (UPNA) Nicolas Sirven (IRDES, Université Paris Descartes) Thierry Rochereau (IRDES, LIRAES)

2 Outline Validity of ESPS 2012 data Determinants of blood donation in France

3 1. Introduction Blood donation rare and necessary No shortage in France according to the EFS Few or incomplete information about blood donors population in France (CREDOC,2007; FNORS, 2010) ESPS 2012 introduces for the first time a module on blood donations Primary source of data

4 1. Introduction ESPS 2012 surveyed ordinary households in two different modalities: Telephone (CATI) Face to Face (CAPI) For the population aged >15 years, there is a specific questionnaire, which included a module on blood donation

5 2. Objectives Compare the blood donors rates that result from ESPS 2012 and those registered by the EFS To analyze differences between active and potential blood donors (we control by health)

6 3. Methods: the ESPS 2012 Questions on blood donation For their classification: active, potential, refused General Questions: Age, gender, residential area Accuracy on information about blood donors Socio-economic: Education, Occupation, Income, Financial difficulties, Behavioural characteristics: willingness to donate organs, social implication, risk aversion Health: self-perception of health

7 Variables of study Altruism Comte (1854), Andreoni (1989, 1990), Crumpler & Grossman (2008), Evans & Ferguson (2013) Social Capital Becker & Murphy (2000), Kawachi & Berkman (1998), Veenstra (2000), Putnam (2000), Kolins & Herron (2003), Alessandrini (2007) Risk Aversion/Propensity Scale 0 (risk averse) -10 (risk prones) No litterature on the relation between risk aversion and blood donation behaviour Socio-Economic factors Income Education Residential Area Health perception and Euro-D score Prince et al (1999b)

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9 3. Methods Three types of donors: Active: declare having donated blood in the last 12 months Potential: they have never donated but not for health reasons Refused: They have donated but not in the last 12 months for health reasons, exceed age (limited at 70) has an ALD (long time illness) or has been transfused (reason for permanent exclusion in France) They have never donated because of health reasons, age, ALD or transfused

10 3. (Regression) Methods Probit model Active vs. Potential donors Excludes Refused donors for the analysis Probit Model with Sample selection Refused vs. Non-Refused (Active + Potential) Selection variables: self-perception of health and Euro-D score

11 4. Results 1st Objective: Validation of data 2nd Objective: Analysis of the determinants of blood donation in France

12 ESPS 2012 vs EFS 2012 Active Donors: 6.48 % /!\ 6.48 % vs 4.54 % => EFS shows 7.3% considering months. So, maybe 12 monts is a flexible concept? Refused Donors: % Potential Donors: %

13 Validation (1st Objective) Comparison data ESPS EFS in terms of % of active donors by: Age and Gender: according ESPS 2012 (7.05% versus 5.8% for women) comparable to the EFS rates. By age ranges there are some disparities for individuals aged and (ESPS finds rates that almost double those registered by the EFS) but are really similar for the rest Regions: (see map)

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15 Age and Gender

16 ESPS 2012 Bretagne 6.64 Pays de la Loire 6.7 Centre- Atlantique 6.98 Nord de France 6.11 Normandie 5.71 Île de France Aquitaine- Limousine Auvergne Loire 6.21 Lorraine- Champagne 9.43 Bourgogne Franche-Comté 7.29 Rhône-Alpes 7.65 Alsace 9.44 Pyrénées-Méditérranées 5.24 Alpes-Mediterranées 4.79

17 EFS 2012 Bretagne 5.92 Île de France 2.81 Normandie 4.37 Pays de la Loire Nord de France 4.2 Île de France 2.81 Centre- Atlantique 4.79 Aquitaine- Limousine Auvergne- Loire 6.04 Pyrrénées-Mediterranées 5.37 Lorraine- Champagne 5.43 Bourgogne Franche-Comté 5.15 Rhone-Alpes 5.48 Alsace 5.89 Alpes- Mediterranées 4.1

18 The determinants of blood donation in France Population and sample Questionnaire modality Population N= Population in age of donating N= Delivered Returned Delivered Returned Working Sample N= Blood donation issue Téléphone (55.85%) (57.44%) 4898 (46,68 %) Face-à-face (82.25%) (84.13%) 5594 (53,31 %)

19 Independent Variables 1. Socio-economic variables Education Income per unit of consumption (quintiles) Occupation: Employed, Retired, Unemployed and Inactive Active donors have high incomes are mostly represented in the fifth quintile. Refused donors have equivalent or lower income than the second quintile and are mostly retired or inactive. Potential donors, meanwhile, tend to have incomes above the third quintile, and are mostly employed instead.

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21 Independent Variables 2. Altruism Willingness to donate organs Having the organ donors card Knowing somebody transfused According to the results, 57.7% of the final sample attrition would be willing to donate their organs upon death. However, 30.4% did not know if they would be 11.56% and would not be willing to do so. Active donors are more often inclined to agree while disqualified do not want to donate their organs and potential donors want to doubt.

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23 3. Social Capital Social support: participation in associations Social Implication: index 0-1 created from responses to 4 items: Over the past 12 months, how long have you been...? (IS1) 1st item: With people in your family living outside the household (IS2) 2nd item: With friends or neighbors (IS3) 3rd item: With colleagues outside work periods (IS4) 4th item: With other people in associations, voluntary organizations, churches, political parties etc.. or each item the answers are: Never (take value 0) Less than monthly (1) At least once a month (2) At least once a week (3), and every day or almost (4). ISindex = 4 4 i= 1 j= 0 i [ IS ] max i j

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25 Social Implication 3 2 Difference ,0625 0,125 0,1875 0,25 0,3125 0,375 0,4375 0,5 0,5625 0,625 0,6875 0,75 0,8125 0,875 0, % Actifs - % Récusés % Actifs - % Potentiels % Récusés - % Potentiels -3-4 Level of social implication

26 4. Risk aversion/propensity Scale 0-10 (0 for the risk averse; 10 for the risk prones)

27 Risk Propensity 4 2 Difference % Actifs - % Récusés % Actifs - % Potentiels % Récusés - % Potentiels -6-8 Level of risk propensity

28 5. Health Related Variables Self perception of health Depression (Euro-D score)

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31 Variables Summary Results Significant Socio-demographic Increase of age -> increase the probability of being active Age donor YES Gender Women are more likely to be refused SELECTION Being on education (having not diploma obtained) Education increases the probability of being active donor YES Residential Area No impact found (opportunity costs?) NO Occupation Being employed increases the prob of being active donor YES Income No effect (not for the money?) NO Financial Difficulties increase the prob of being refused YES Behavioural Indirect altruism Those who did not anwer -> decrease the prob of being active donor SELECTION Direct altruism (WTD) Increases the prob of being active donor YES Participation in assoc Increases the prob of being active donor YES Risk propensity Increases the prob of being active donor YES Health bad SRH Increases the prob of being refused donor SELECTION Chronic Increases the prob of being refused donor SELECTION Depression (Euro-D score) Increases the prob of being refused donor SELECTION

32 1st Objective Conclusion The sample ESPS seems quite robust with regard to the information collected by the EFS. Nevertheless, the analysis of the determinants of blood donation must consider and interpret some disparities to clarify the importance of factors poorly studied so far in blood donation.

33 2nd Objective Conclusion The results show that active donors are generally more altruistic individuals with higher levels of participation in social activities, but also all other things being equal, individuals who have a greater propensity to take risks. There is also a difference between non-refused and refused donors in terms of health but this difference is not significant between active and potential donors, suggesting that using an appropriate health policy potential donors could be crowded-in

34 General Conclusion The introduction of a module of questions about blood donation in the ESPS 2012 questionnaire allows for the first time in France to encounter aspects of blood donation with economic, social and health variables in the general population. The present study is based on a classification of donors based on grounds for exclusion imposed by the EFS. One possibility is to exclude from the analysis donors objected on the grounds of permanent health. The analysis therefore focuses on individual factors that promote blood donation among the population in age and ability to donate. The contribution of economic analysis can enrich the knowledge of the individual behavior on blood donation. Assumptions about the normative dimension of the act of giving ( altruism, social mimicry, etc.. ) were made and the role of risk aversion was taken into account.

35 Thank you!