Bivariate mixture modeling was used to analyze joint population distributions of transferrin saturation (TS) and serum ferritin concentration (SF) measured in the Hemochromatosis andIron Overload Screening (HEIRS) Study. Four components (C1, C2, C3, and C4) with successively age-adjusted increasing means for TS and SF were identified in data from 26,832 African Americans, 12,620 Asians, 12,264 Hispanics, and 43,254 whites. The largest component, C2, had normal mean TS (21% to 26% for women, 29% to 30% for men) and SF (43-82 g/L for women, 165-242 g/L for men), which consisted of component proportions greater than 0.59 for women and greater than 0.68 for men. C3 and C4 had progressively greater mean values for TS and SF with progressively lesser component proportions. C1 had mean TS values less than 16% for women (<20% for men) and SF values less than 28 g/L for women (<47 g/L for men). Compared with C2, adjusted odds of iron deficiency were significantly greater in C1 (14.9-47.5 for women, 60.6-3530 for men), adjusted odds of liver disease were significantly greater in C3 and C4 for African-American women and all men, and adjusted odds of any HFE mutation were increased in C3 (1.4-1.8 for women, 1.2-1.9 for men) and in C4 for Hispanic and white women (1.5 and 5.2, respectively) and men (2.8 and 4.7, respectively). Joint mixture modeling identifies a component with lesser SF and TS at risk for iron deficiency and 2 components with greater SF and TS at risk for liver disease or
97Transferrin saturation (TS) and serum ferritin concentration (SF) are iron measures, the levels of which are influenced by iron stores, a variety of inflammatory and neoplastic disorders, and inheritance of alleles in ironrelated genes. C282Y is a common missense mutation of the HFE gene, 1 which is detected typically in whites of northern European ancestry; however, the HFE H63D allele occurs in most race/ethnic groups worldwide.2 In Caucasian participants enrolled in a screening study conducted at the Kaiser Permanente San Diego Health Appraisal Clinic, components of TS identified by mixture modeling corresponded to distributions of HFE genotypes.3 The Hemochromatosis and Iron Overload Screening (HEIRS) Study is a large, multicenter screening study in which TS, SF, and HFE mutations were measured for each participant.4,5 Analyses of phenotypic and genotypic data collected from 44,136 non-Hispanic Caucasian participants in the HEIRS Study enrolled in different geographic regions demonstrated a strong association between the HFE genotype and the TS subpopulations. The analyses also confirmed the validity of the mixture modeling approach when applied to a convenience sample of patients observed at primary care clinics and at blood drawing facilities. 6 In contrast with previous investigations that modeled the univariate distribution of TS, we now report detailed analyses of the bivariate distribution of TS and SF values from African Americans, Asians, Hispanics, and non-Hispanic whites enrolled in the HEIRS Study.The following hypotheses ...