Blog from Michael Kleerekoper, MD, MACE: Ethnicity and the lab

At the University of Toledo Medical Center, where I work, the laboratory reports estimated Glomerular Filtration Rate (eGFR) data separately for African Americans and non-African Americans. There is merit in that. I’m interested in looking at all the other lab differences in ethnicity that are ignored.

I have done a reasonably long review of the relevant data on PubMed, but lab data related to ethnicity are sparse and tend to be population dependent.

Added to that, the specimens we send to specific labs for less common lab data are usually not population or ethnicity-dependent – they are “one size fits all.”

Michael Kleerekoper

Biloxi, Mississippi; Boston, Massachusetts; Boyne, Michigan; and Billings, Montana all have a “B and M” but not too much else in common. They are great cities, but the climates are different, as are the populations. It’s possible that lab testing could be better customized for specific populations based on genetic differences in race or possibly gender.

In prenatal testing for genetic diseases, ethnicity is often considered a risk factor for certain diseases – sickle cell disease in African Americans or Tay-Sachs in Ashkenazi Jewish. Are endocrinologists as a group missing out on opportunities to provide earlier, more accurate diagnoses, because they do not test for ethnicity-specific diseases? Or perhaps connecting extent of disease or successful treatments to a person’s race?

I would like to hear and learn from readers of this blog what other important lab items should be earmarked for ethnicity-specific — and perhaps even gender-specific — analysis.

Endocrine Today has published several items over the years related to ethnicity-specific diseases. It could be helpful to review all we know about disease rates and ethnicity to better refine lab testing practices.

A quick look back:
Severity of hyperandrogenism in PCOS can differ across ethnicities (2006)

Consider ethnic, cultural influences on childhood obesity (2008)

Ethnic considerations of metabolic syndrome and body composition (2009)

Race, genetics explained variations in 25-hydroxyvitamin D (2013)

And more recent perspectives:
Video: Specialized care recommendations for Hispanic patients with diabetes (2014)

Genetic ancestry data could improve PCOS classification, treatment (2014)

The question to ask here is, how have our testing practices changed to keep pace with our growing knowledge of the links between certain diseases and ethnicities? What are the barriers or downfalls to analyzing labs from this perspective?