Comparison of Lipid Results From 2007 to 2009 via Commercial Clinical Laboratory Testing Versus a Population-Based Cohort: Proof-of-Concept for Population Health Monitoring of Lipids Using Commercial Lab Data

BACKGROUND: Large commercial laboratories serve millions of patients and generate billions of test results annually. The objective of our study was to assess the potential use of commercial laboratory lipid testing for population health monitoring. METHODS: codes listing diabetes or cardiovascular disease as the indication for testing. The associations between abnormal lipid levels (high-density lipoprotein cholesterol <50 mg/dL in women and <40 mg/dL in men, low-density lipoprotein cholesterol ≥130 mg/dL, triglycerides ≥150 mg/dL) and residency in any of 76 ZIP codes was assessed in the commercial laboratory population using logistic regression adjusting for age and sex. RESULTS: The distribution plots of high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, and triglycerides were broadly similar in a commercial laboratory population (n=59 419; median age [interquartile range], 48 [33-58] years; 56% women) and DHS-2 (n=3147; median age [interquartile range], 50 [42-58] years; 60% women). Median high-density lipoprotein cholesterol was 1 mg/dL lower (95% CI 0.6-2), low-density lipoprotein cholesterol was 5 mg/dL lower (95% CI 3-6), and triglycerides were 12 mg/dL higher (95% CI 9-14) in the commercial laboratory population versus DHS-2. Similar results were observed in a sensitivity analysis that excluded those with diabetes or cardiovascular disease. Higher probabilities of abnormal levels of all 3 lipids were observed for 5 ZIP codes (odds ratios [95% CI] ranged from 1.07 [1.001-1.15] to 1.84 [1.48-2.28]). CONCLUSIONS: Within the same geographic region, the differences between lipids observed in commercial laboratory testing and in a population-based cohort were negligible (high-density lipoprotein cholesterol) to moderate (low-density lipoprotein cholesterol, triglycerides). This proof-of-concept study suggests that commercial laboratory testing may be useful for monitoring population lipid levels and assessing regional and temporal variation.