Cardiometabolic Risk and Diagnostic-Laboratory Reference-Range Disagreement in 794,811 Indian Insurance Applicants: An Aggregate Analysis of Digitized Medical Examinations
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This study analyzes 794,811 digitized medical examinations from Indian life-insurance applicants, a working-age, urban-skewed demographic often undersampled by national surveys. The cohort exhibits a pronounced South-Asian cardiometabolic risk profile: among valid adult records, 41.9% met the criteria for dyslipidemia (driven heavily by low HDL and elevated triglycerides), and 61.4% met AHA 2017 criteria for stage 1 hypertension. However, canonicalizing this dataset across 33,244 diagnostic centers revealed significant heterogeneity in laboratory reference ranges. At the clinical prediabetes threshold of 110 mg/dL for fasting blood sugar, the record-pair disagreement rate across laboratories was 49.7%, with similar variance across other common tests. This structural inconsistency materially affects patient classification and the tracking of disease prevalence, underscoring a critical need for the national standardization of laboratory reporting in India.
