Increasing diversity within the Global Lung Function Initiative

Hall, Graham L.; Cooper, Brendan

doi:10.1111/resp.13373

Cited by 2 publications

(1 citation statement)

References 7 publications

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“…At the transition between pediatric to adulthood (classically 18 years of age), using both pediatric and adult reference equations on the same patient could yield results varying by −14% to 38%, making their interpretation and subsequent decision-making difficult [62]. Age can further compound with race and ethnicity-among older patients from less adequately represented subgroups, e.g., older Asian patients, GLI equations were found to be less accurate than in other subgroups [63][64][65]. Therefore, determinations based on a single, nonadaptive threshold may negatively affect a broad array of clinical decisions-ranging from the prescription of medications [66] to the timely recognition of occupational lung disease [67], disease workup, and management [68].…”

Section: Plos Digital Healthmentioning

confidence: 99%

Going beyond the means: Exploring the role of bias from digital determinants of health in technologies

Charpignon,

Carrel,

Jiang

et al. 2023

PLOS Digit Health

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Background In light of recent retrospective studies revealing evidence of disparities in access to medical technology and of bias in measurements, this narrative review assesses digital determinants of health (DDoH) in both technologies and medical formulae that demonstrate either evidence of bias or suboptimal performance, identifies potential mechanisms behind such bias, and proposes potential methods or avenues that can guide future efforts to address these disparities. Approach Mechanisms are broadly grouped into physical and biological biases (e.g., pulse oximetry, non-contact infrared thermometry [NCIT]), interaction of human factors and cultural practices (e.g., electroencephalography [EEG]), and interpretation bias (e.g, pulmonary function tests [PFT], optical coherence tomography [OCT], and Humphrey visual field [HVF] testing). This review scope specifically excludes technologies incorporating artificial intelligence and machine learning. For each technology, we identify both clinical and research recommendations. Conclusions Many of the DDoH mechanisms encountered in medical technologies and formulae result in lower accuracy or lower validity when applied to patients outside the initial scope of development or validation. Our clinical recommendations caution clinical users in completely trusting result validity and suggest correlating with other measurement modalities robust to the DDoH mechanism (e.g., arterial blood gas for pulse oximetry, core temperatures for NCIT). Our research recommendations suggest not only increasing diversity in development and validation, but also awareness in the modalities of diversity required (e.g., skin pigmentation for pulse oximetry but skin pigmentation and sex/hormonal variation for NCIT). By increasing diversity that better reflects patients in all scenarios of use, we can mitigate DDoH mechanisms and increase trust and validity in clinical practice and research.

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Section: Plos Digital Healthmentioning

confidence: 99%

Going beyond the means: Exploring the role of bias from digital determinants of health in technologies

Charpignon,

Carrel,

Jiang

et al. 2023

PLOS Digit Health

View full text Add to dashboard Cite

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Reference equations for evaluation of spirometry function tests in South Asia, and among South Asians living in other countries

et al. 2022

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BackgroundThere is little data to accurate interpretation of spirometry data in South Asia, a major global region with high reported burden for chronic respiratory disease.MethodWe measured lung function in 7,453 healthy men and women aged over 18 years, from Bangladesh, North India, South India, Pakistan and Sri Lanka, as part of the South Asia Biobank study. We first assessed the accuracy of existing equations for predicting normal forced vital capacity (FVC), forced expiratory volume in 1 s (FEV1), and FEV1/FVC ratio. We then used our data to derive (N=5589) and internally validate (N=1864) new prediction equations amongst South Asians, with further external validation amongst 339 healthy South Asians living in Singapore.ResultsGLI2012 and NHANESIII consistently overestimated expiratory volumes (best fit GLI-African American, mean [sd] z-score (n=7453): FEV1 −0.94 [1.05]; FVC −0.91 [1.10]). Age, height and weight were strong predictors of lung function in our participants (p<0.001), and sex specific reference equations using these three variables were highly accurate in both internal validation (z-scores: FEV1 0.03 [0.99]; FVC 0.04 [0.97]; FEV1/FVC −0.03 [0.99]) and external validation (z-scores: FEV1 0.31 [0.99]; FVC 0.24 [0.97]; FEV1/FVC 0.16 [0.91]). Further adjustment for study regions improves the model fit, with highest accuracy for estimation of region specific lung function in South Asia.ConclusionWe present improved equations for predicting lung function in South Asians. These offer the opportunity to enhance diagnosis and management of acute and chronic lung diseases in this major global population.

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Increasing diversity within the Global Lung Function Initiative

Abstract: https://onlinelibrary.wiley.com/doi/10.1111/resp.13330

Cited by 2 publications

References 7 publications

Going beyond the means: Exploring the role of bias from digital determinants of health in technologies

Going beyond the means: Exploring the role of bias from digital determinants of health in technologies

Reference equations for evaluation of spirometry function tests in South Asia, and among South Asians living in other countries

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