Towards better clinical laboratory diagnostic criteria for haemoglobin concentration: results from the Survey on Health Examination and Physiological Constants in China

Abstract

BackgroundThe Survey on Health Examination and Physiological Constants is a programme of multidisciplinary studies designed to assess the health status and physiological constants of adults in China. Differences in physiological constants, such as height and body-mass index, exist among different ethnic populations in China but, for a long time, foreign standards have been used for the assessment of overweight and obesity. The goal of this project is to study reference intervals for physiological constants in different ethnic populations, so that these data can be used to enhance clinical diagnosis strategies and health promotion in China. MethodsA cross-sectional survey with multistage, stratified cluster design examines a representative sample of about 51 000 individuals (aged 20–80 years) from different ethnic populations in ten provinces in 2012–18. The survey is unique in that it combines personal interviews with standardised physical examinations, diagnostic procedures, and laboratory tests to obtain information about diagnosed and undiagnosed conditions; growth and development, including obesity, eyesight, bone density, and respiratory function; lifestyle; and exposure to risk factors. Written informed consent was obtained from all participants before data collection. The study was approved by the Bioethical Committee of the Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences, Beijing, China (approval number 028–2013). FindingsHaemoglobin concentration has risen strikingly in a sample of healthy Chinese subjects (n=8818), as living standards improve in China. For haemoglobin concentration, 640 (56%) of 1137 male and 294 (18%) of 1670 female adults older than 20 years have exceeded the present clinical laboratory diagnostic criteria (120–160 g/L for men and 110–150 g/L for women) in the Han population, compared with 446 (38%) of 1163 men and 170 (11%) of 1580 women in the Bouyei population, and 406 (39%) of 1030 men and 216 (11%) of 1924 women in the Uygur population. Participants from other ethnic groups were excluded in the analysis. InterpretationWith the development of social economy and improvement of nutritional status in different ethnic populations in China, it is necessary to study the trends of change for some physiological constants and modify the related clinical diagnosis criteria. For example, such knowledge will improve diagnosis and treatment strategies of the related diseases to establish the normal reference value of haemoglobin among different ethnic populations in China. FundingThe study was supported by the National Science and Technology Pillar Program during the Twelfth Five-Year Plan Period sponsored by the Ministry of Science and Technology of China (Grant 2012BAI37B02) and the Key Program special for Science and Technology Foundation work (Grant 2013FY114100). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the abstract.