Comparing Ethnicity-Specific Reference Intervals for Clinical Laboratory Tests from EHR Data

Nadav Rappoport; Hyojung Paik; Boris Oskotsky; Ruth Tor; Elad Ziv; Noah Zaitlen; Atul J Butte

doi:10.1373/jalm.2018.026492

Comparing Ethnicity-Specific Reference Intervals for Clinical Laboratory Tests from EHR Data

J Appl Lab Med. 2018 Nov 1;3(3):366-377. doi: 10.1373/jalm.2018.026492.

Authors

Nadav Rappoport^{1

2}, Hyojung Paik^{1

2

3}, Boris Oskotsky¹, Ruth Tor⁴, Elad Ziv^{5

6

7}, Noah Zaitlen⁵, Atul J Butte^{1

2

5}

Affiliations

¹ Institute for Computational Health Sciences, University of California, San Francisco, CA.
² Department of Pediatrics, University of California, San Francisco, San Francisco, CA.
³ Korea Institute of Science and Technology Information, Biomedical Convergence Technology Research Division, Biomedical HPC Technology Research Center, Deajeon, South Korea.
⁴ Rabin Medical Center, Beilinson Hospital, Petach Tikva, Israel.
⁵ Institute for Human Genetics, University of California, San Francisco, San Francisco, CA.
⁶ Department of Medicine, University of California, San Francisco, San Francisco, CA.
⁷ Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, San Francisco, CA.

Abstract

Background: The results of clinical laboratory tests are an essential component of medical decision-making. To guide interpretation, test results are returned with reference intervals defined by the range in which the central 95% of values occur in healthy individuals. Clinical laboratories often set their own reference intervals to accommodate variation in local population and instrumentation. For some tests, reference intervals change as a function of sex, age, and self-identified race and ethnicity.

Methods: In this work, we develop a novel approach, which leverages electronic health record data, to identify healthy individuals and tests for differences in laboratory test values between populations.

Results: We found that the distributions of >50% of laboratory tests with currently fixed reference intervals differ among self-identified racial and ethnic groups (SIREs) in healthy individuals.

Conclusions: Our results confirm the known SIRE-specific differences in creatinine and suggest that more research needs to be done to determine the clinical implications of using one-size-fits-all reference intervals for other tests with SIRE-specific distributions.

Abstract

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