Coagulation and Transfusion Medicine / ABO Blood Type and Longevity
ABO Blood Type and Longevity
Mark E. Brecher, MD,* and Shauna N. Hay, MPH
Key Words: Epidemiology; Death; ABO; Blood group; Longevity
DOI: 10.1309/AJCPMIHJ6L3RPHZX
Abstract
To assess the observation that blood type B might
be a marker for longevity, we reviewed the records
and determined the ABO blood types of all patients
who died in our hospital in 2004. Age was stratified
by decade of death, and linear regressions were
calculated by ABO percentage. ABO survival curves
were compared.
In 2004, 906 patients died; 35 were excluded
(stillborn infants). Of the remaining 871 patients, ABO
types were available for 772 (88.6%). The percentage
of patients with group B blood declined with age (P <
.01). None of the other blood type percentages had a
statistically significant increase or decrease. The group
B survival curve was statistically worse than non-B
groups (P ≤ .01); there were no differences in survival
among groups A, O, and AB
(P = .47).
In our patient population, the percentage of
patients with group B blood declines with age. The
survival curve in group B was worse than that in
groups A, O, and AB. These findings suggest that in
our patient population, blood group B is not a marker
for longevity but may be a marker for earlier death.
96 Am J Clin Pathol 2011;135:96-98
96 DOI: 10.1309/AJCPMIHJ6L3RPHZX
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Based on a survey of 269 centenarians (people older than
100 years) living in Tokyo, Japan, it was suggested that blood
type B might be a marker for longevity.1 To assess the valid-
ity and generalizability of this observation, we determined the
ABO blood type of patients dying in our tertiary care hospital
located in the United States. If blood group B was a marker of
longevity, it would be expected that the percentage of patients
with blood group B would increase with age at the time of
death and the percentages of the other groups would decline.
Similarly, it would be expected that the survival of patients
with blood group B would differ significantly from patients
with the other ABO blood groups.
Materials and Methods
A retrospective review of blood bank and electronic
clinical records was conducted for all patients who died at our
institution from January 1, 2004, through December 31, 2004.
Stillborn infants were excluded from analysis. Age at time of
death was stratified by decade of death, and linear regressions
were calculated by ABO type. Survival curves comparing the
different ABO blood groups were also constructed.
Statistical significance was taken at a P value of .05 or
less. Survival curves were compared by means of a log-rank
test (MedCalc for Windows, Mariakerke, Belgium).
Results
A total of 906 patients died in 2004 at our institution,
and 35 (stillborn infants) were excluded from the study. Of
the remaining 871 patients, ABO types were available for
772 patients (88.6%). The age distribution ranged from day
© American Society for Clinical Pathology
 Coagulation and Transfusion Medicine / Original Article

Discussion
80
70 Shimizu et al1 reported on a survey of the ABO blood
60
types of centenarians (people older than 100 years) living
Group O
in Tokyo. The frequencies of blood types A, O, B, and AB
50
of the 269 centenarians were 34.2%, 28.3%, 29.4%, and
Percent

40
Group A 8.2%, respectively, whereas the frequencies in 7,153 control
30
subjects were 38.6%, 30.1%, 21.9%, and 9.4%, respectively.
20 Group B The blood type B was statistically more frequent among the
10 centenarians than in the control subjects (29.4% vs 21.9%; P
Group AB
0 = .04). From these findings, the authors concluded that blood
0 1 2 3 4 5 6 7 8 9 10 11
Decade of Death
group B might be associated with exceptional longevity.
The association of ABO blood type with health and lon-

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❚Figure 1❚ Percentage of ABO groups stratified by decade of
death. Only the slope for group B is statistically significant
(2-sided P < .01), with a correlation coefficient squared (R2)
of 0.68. For group B, only 3 people were alive in the eighth
decade of life, and none were alive in the ninth decade of
life. These small numbers greatly contributed to the negative
slope of the regression line.
of birth to 97 years. The percentage of patients with group B
blood stratified by decade of death declined with age ❚Figure
1❚ (P < .01; R2 = 0.68). None of the other blood type per-
centages had a statistically significant increase or decrease
when plotted against decade of death ❚Table 1❚. Patients with
group B blood had an overall decreased survival (P = .01)
compared with patients with the other blood groups ❚Figure
2❚. Individually, survival of patients with group B blood sig-
nificantly differed from patient with group A blood (P < .01),
group O blood (P < .01), and group AB blood (P = .01). There
were no survival differences in patients with groups A, O, and
AB blood (P = .47).
gevity should not be surprising. It has been shown that ABO
blood groups are a major determinant of plasma levels of
factor VIII (FVIII) and von Willebrand factor (vWF).2 People
with blood group O have approximately 25% lower plasma
levels of both glycoproteins.2 Low plasma levels of FVIII and
vWF have long been established as causes of excess bleeding,
and there is evidence that elevated FVIII and vWF levels may
represent risk factors for ischemic heart disease and venous
thromboembolic disease. For example, blood group A in
women younger than 50 years has been reported to be a signif-
icant risk factor for myocardial infarction.3 Similarly, a mul-
tinational study (United Kingdom, Sweden, and the United
States) assembled from multiple sources (drug-surveillance
programs, retrospective record searches, questionnaires, and
information from the Committee on Safety of Drugs in the
United Kingdom) found that the odds ratio or relative risk of
venous thromboembolism was 1.9 when comparing subjects
100
Group A

80 Group AB
❚Table 1❚
Survival Probability (%)

ABO Groups of 772 Patients Stratified by Decade of Death*

Group O
Blood Group 60

Group B
Decade of Death O (n = 390) A (n = 265) B (n = 91) AB (n = 26)
40
1 (n = 88) 47 (53) 25 (28) 14 (16) 2 (2)
2 (n = 19) 10 (53) 5 (26) 3 (16) 1 (5)
3 (n = 34) 17 (50) 9 (26) 8 (24) 0 (0)
4 (n = 47) 28 (60) 11 (23) 8 (17) 0 (0) 20
5 (n = 99) 48 (48) 36 (36) 11 (11) 4 (4)
6 (n = 144) 78 (54) 46 (32) 15 (10) 5 (3)
7 (n = 129) 56 (43) 54 (42) 14 (11) 5 (4) 0
8 (n = 117) 53 (45) 45 (38) 15 (13) 4 (3) 0 20 40 60 80 100
9 (n = 88) 48 (55) 32 (36) 3 (3) 5 (6)
10 (n = 7) 5 (71) 2 (29) 0 (0) 0 (0) Time (y)
R2 0.06 0.30 0.68 <0.01
Linear regression 0.66 1.11 –1.83 0.06 ❚Figure 2❚ Survival curves showing the decreased survival
slope of people with group B blood compared with people with
P (2-tailed) .48 .10 <.01 .80
groups O, A, and AB over time (P ≤ .01). There was no
* Values are given as number (percentage) unless otherwise indicated. statistical difference in groups A, O, and AB (P = .47).

© American Society for Clinical Pathology Am J Clin Pathol 2011;135:96-98 97

97 DOI: 10.1309/AJCPMIHJ6L3RPHZX 97
Brecher and Hay / ABO Blood Type and Longevity
with non-O blood groups with subjects with blood group O.
The strongest association (odds ratio, 2.7) was found among
pregnant women.4 More recently, in a study from Denmark,
blood groups A and AB were reported to be associated with
increased risks for deep venous thrombosis (DVT) and pul-
monary embolism in pregnancy (odds ratio, 3.9) and the
puerperium (odds ratio, 2.4).5
Associations with the ABO blood groups and other
disease states have been reported. For example, it has been
found that people with blood group O are at increased risk of
peptic ulcers.6 This seems to be due to enhanced binding of
Helicobacter pylori to the epithelial cells of people with blood
group O and to an enhanced inflammatory response seen with
group O leukocytes (increased interleukin-6 and tumor necro-
sis factor).6 It has also been reported that inflammation-related
risk factors for lung cancer death were significantly stronger
among males with phenotype O than A in the Copenhagen
Male Study.7 Endometrial and ovarian cancers have been
reported to occur more frequently and have a poorer progno-
sis in women with group A blood than in women with non-A
blood group types.8 Finally, the distribution of ABO blood
types has been reported as a strong predictor of national sui-
cide and homicide rates.9,10
A priori, it is impossible to say what the ultimate influ-
ence of differing risk factors that have been associated with
ABO blood groups would have on overall longevity. Thus, we
looked at the overall survival of people dying in our hospital
and the percentages by blood group (stratified by decade of
death). In both analyses of this data set, people with group B
blood fared statistically worse than people with groups A, O,
and AB. This observation would seem to contradict the find-
ings by Shimizu et al.1 However, their observation was based
on observing centenarians. The present study included no
centenarians, which may be a reason for the discordance in the
conclusions of the 2 studies. It is also worth noting that in the
study by Shimizu et al,1 the percentage of people with group
B blood in an “old” control subgroup (n = 740; aged 70-93
years) was 21.5% and in an “elderly old” control subgroup (n
= 118; aged 80-93 years) was 22.9%. Both percentages were
very similar to that for the overall control group (n = 7,153) of
21.9%. Thus, their observation of increased longevity seemed
limited to the extreme of old age (centenarians).
In our patient population, the percentage of patients with
blood group B and survival decline with age (P < .01). These
98 Am J Clin Pathol 2011;135:96-98
98 DOI: 10.1309/AJCPMIHJ6L3RPHZX
findings suggest that in our patient population, group B is not
a marker for longevity but may be a marker for earlier death.
Larger studies will be necessary in other locations and for a
longer period to determine if this is a reproducible observa-
tion and to possibly identify possible explanations for any
observed effect of blood type on longevity (eg, race). Such a
multi-institutional study is being planned.
From the Department of Pathology and Laboratory Medicine,
University of North Carolina, Chapel Hill.
Address reprint requests to Dr Brecher: Laboratory
Corporation of America, 531 S Spring St, Burlington, NC 27215.
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* Dr Brecher is currently the chief medical officer,
Laboratory Corporation of America. His work on this study and
this article was not done in his current capacity.
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© American Society for Clinical Pathology