Effect of Race and Ethnicity on Pulmonary Function Testing Interpretation

Marciniuk, Darcy; Becker, Ellen A; Kaminsky, David A.; McCormack, Meredith C.; Stanojevic, Sanja; Bhakta, Nirav R.; Bime, Christian; Comondore, Vikram R.; Cowl, Clayton T.; Dell, Sharon D.; Haynes, Jeffrey; Jaffe, Fred; Mottram, Carl D.; Sederstrom, Nneka; Townsend, Mary K.; Iaccarino, Jonathan M.

doi:10.1016/j.chest.2023.03.026

Cited by 14 publications

(4 citation statements)

References 48 publications

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“…The inclusion of the lung function parameters from other ethnic groups in the development of these composite equations explains the differences in the predictions when compared to the GLI SE Asian ethnic‐specific equations. There were studies showing that important population health outcomes, such as mortality and clinical events in COPD, were better predicted by using a standard reference set for all individuals, rather than an ethnic‐specific reference, implying that race‐specific values potentially mask modifiable risk factors for inferior lung function seen in non‐White ethnic groups 31–33 . Whether the use of race‐neutral equations would improve the lung function interpretation (by reducing the mislabelling of individuals from disadvantaged communities with impaired lung function as healthy), and ultimately lead to better outcomes requires further studies to investigate.…”

Section: Discussionmentioning

confidence: 99%

Applicability of the Global Lung Function Initiative prediction equations in Hong Kong Chinese children

Chan,

Zhu,

et al. 2023

Pediatric Pulmonology

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Background and ObjectiveThis study aimed to assess the applicability of the Global Lung Function Initiative (GLI) prediction equations for spirometry in Hong Kong children and to develop prediction equations based on the Generalized Additive Models for Location, Scale, and Shape (GAMLSS) modeling.MethodsHealthy Chinese children and adolescents aged 6–17 years old were recruited from randomly selected schools to undergo spirometry. The measurements were transformed to z‐score according to the GLI‐2012 equations for South East (SE) Asians and the GLI‐2022 global race‐neutral equations. Prediction equations for spirometric indices were developed with GAMLSS modeling to identify predictors.ResultsA total of 886 children (477 boys) with a mean age of 12.5 years (standard deviation [SD] 3.3 years) were included. By the GLI‐2012 SE Asian equations, positive mean z‐scores were observed in forced expiratory volume in 1 s (FEV1) (boys: 0.138 ± SD 0.828; girls: 0.206 ± 0.823) and forced vital capacity (FVC) (boys: 0.160 ± 0.930; girls: 0.310 ± 0.895) in both sexes. Negative mean z‐scores were observed in FEV1/FVC ratio (boys: −0.018 ± 0.998; girls: −0.223 ± 0.897). In contrast, negative mean z‐scores in FEV1 and FVC, and positive mean z‐scores in FEV1/FVC were observed when adopting the GLI‐2022 race‐neutral equations. The mean z‐scores were all within the range of ±0.5. By GAMLSS models, age and height were significant predictors for all four spirometric indices, while weight was an additional predictor for FVC and FEV1.ConclusionOur study provided data supporting the applicability of the GLI prediction equations in Hong Kong Chinese children. The GLI‐2012 equations may underestimate FEV1 and FVC, while the GLI‐2022 equations may overestimate the parameters, but the differences lie within the physiological limits. By GAMLSS modeling, weight was an additional predictor for FVC and FEV1.

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Section: Discussionmentioning

confidence: 99%

Applicability of the Global Lung Function Initiative prediction equations in Hong Kong Chinese children

Chan,

Zhu,

et al. 2023

Pediatric Pulmonology

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“…categorization of race and ethnicity, with poor correlation to genetic ancestry, as a justification for 'improving' the precision of lung function test interpretation (Marciniuk et al, 2023;Stanojevic et al, 2022).…”

Section: Author Contributionsmentioning

confidence: 99%

“…The historic white‐European centric evidence has led to an underestimation of lung disease for many people around the world. We must therefore question the utility of using an imprecise categorization of race and ethnicity, with poor correlation to genetic ancestry, as a justification for ‘improving’ the precision of lung function test interpretation (Marciniuk et al., 2023; Stanojevic et al., 2022).…”

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confidence: 99%

Is lung function in a race against time?

Cooper,

Stanojevic

2024

Experimental Physiology

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Is lung function in a race against time?It has been evident from the earliest studies of vital capacity that in addition to standing height, social class, occupation and factors that we now refer to as the social determinants of health have a profound influence on both lung size and function (Hegewald & Crapo, 2007;Kouri et al., 2021). Over nearly 200 hundred years, hundreds of research studies have highlighted that biological variability of lung function within and between populations persists even after adjusting for standing height. Several studies also demonstrated differences in vital capacity between racial groups, and attributed these to biological or innate factors (Braun et al., 2013;Wolff, 2006). This misconception perpetuated the belief that black individuals were inferior and justified slave practices for many decades (Braun, 2005;Wolff, 2006). Indeed, there are measurable differences in lung function between individuals of different geographical or ancestral backgrounds, but the causal mechanism are the result of a myriad exposures over the life course (Stocks et al., 2013). Critically, the vast majority of research studies that investigated differences in lung function between populations, or

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“…This practice may foster disparities in healthcare as it will miss patients with isolated diffusion defect – a phenotype not only associated with higher mortality but also known to occur more commonly in Black individuals. In addition, use of race-based pulmonary function equations has also been shown to misclassify and underdiagnose Black individuals with severe disease and should be discouraged [32,33 ▪▪ ,34 ▪▪ ,35 ▪ ,36].…”

Section: Diversity and Disparity In The Clinical Presentation Of Sarc...mentioning

confidence: 99%

Diversity and disparity in the treatment and care of sarcoidosis

Ndili

2023

Current Opinion in Pulmonary Medicine

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Purpose of review Clinical presentation and outcomes in patients with sarcoidosis vary by race, gender, ethnicity, and geolocation. African Americans and female individuals have the highest incidence of disease. They are also more likely to present with advanced and more severe forms of disease, and to die from sarcoidosis. African American female individuals have the highest disease-associated mortality, yet this varies by geolocation. The diverse presentation and outcomes in sarcoidosis have often been attributed to genetics and biology, yet this may not be entirely so. Recent findings Several studies have shown that African Americans and female individuals are more likely to earn less and be more socioeconomically disadvantaged in society. Patients with sarcoidosis earning in the lowest income strata presented with the most severe disease and reported more barriers to care. It is plausible that the racial, gender, and geospatial differences in sarcoidosis are more reflective of healthcare disparities than genetics or biology alone. Summary Preventable differences in the burden of disease and in the opportunities to achieve optimal health outcomes that are differentially experienced by groups of people disadvantaged by race, gender, ethnicity, or socioeconomic background should be identified and addressed.

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Effect of Race and Ethnicity on Pulmonary Function Testing Interpretation

Cited by 14 publications

References 48 publications

Applicability of the Global Lung Function Initiative prediction equations in Hong Kong Chinese children

Applicability of the Global Lung Function Initiative prediction equations in Hong Kong Chinese children

Is lung function in a race against time?

Diversity and disparity in the treatment and care of sarcoidosis

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