Race/Ethnicity, Spirometry Reference Equations, and Prediction of Incident Clinical Events: The Multi-Ethnic Study of Atherosclerosis (MESA) Lung Study

Elmaleh-Sachs, Arielle; Balte, Pallavi; Oelsner, Elizabeth C.; Allen, Norrina B; Baugh, Aaron D.; Bertoni, Alain G.; Hankinson, John; Pankow, James S.; Post, Wendy S.; Schwartz, Joseph; Smith, Benjamin M.; Watson, Karol E.; Barr, R. Graham

doi:10.1164/rccm.202107-1612oc

Cited by 66 publications

(37 citation statements)

References 46 publications

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“…The present findings extend previous reports that racerelated differences in mortality were attenuated by applying using the same prediction equation (reference values for whites) across the population [25]. The findings are consistent with recent reports that using race-specific reference values did not improve prediction of respiratory morbidity or mortality in a large cohort study [26], and even predicted clinically important outcomes worse (than using a common reference) in black and white people at high risk of COPD (n = 2,652) [27]. A study using NHANES III data found that the lower lung function in black people had similar implications for all-cause mortality as similarly low lung function in white people, [28].…”

Section: Discussionsupporting

confidence: 92%

Race-specific reference values and lung function impairment, breathlessness and prognosis: Analysis of NHANES 2007–2012

Ekström

Mannino

2022

Respir Res

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Background Spirometry reference values differ by race/ethnicity, which is controversial. We evaluated the effect of race-specific references on prevalence of lung function impairment and its relation to breathlessness and mortality in the US population. Methods Population-based analysis of the National Health and Nutrition Examination Survey (NHANES) 2007–2012. Race/ethnicity was analyzed as black, white, or other. Reference values for forced expiratory volume in one second (FEV1) and forced vital capacity (FVC) were calculated for each person using the Global Lung Initiative (GLI)-2012 equations for (1) white; (2) black; and (3) other/mixed people. Outcomes were prevalence of lung function impairment (< lower limit of normal [LLN]), moderate/severe impairment (< 50%pred); exertional breathlessness; and mortality until 31 December, 2015. Results We studied 14,123 people (50% female). Compared to those for white, black reference values identified markedly fewer cases of lung function impairment (FEV1) both in black people (9.3% vs. 36.9%) and other non-white (1.5% vs. 9.5%); and prevalence of moderate/severe impairment was approximately halved. Outcomes by impairment differed by reference used: white (best), other/mixed (intermediate), and black (worst outcomes). Black people with FEV1 ≥ LLNblack but < LLNwhite had 48% increased rate of breathlessness and almost doubled mortality, compared to blacks ≥ LLNwhite. White references identified people with good outcomes similarly in black and white people. Findings were similar for FEV1 and FVC. Conclusion Compared to using a common reference (for white) across the population, race-specific spirometry references did not improve prediction of breathlessness and prognosis, and may misclassify lung function as normal despite worse outcomes in black people.

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Section: Discussionsupporting

confidence: 92%

Race-specific reference values and lung function impairment, breathlessness and prognosis: Analysis of NHANES 2007–2012

Ekström

Mannino

2022

Respir Res

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“…To a lesser degree, Algerians are descendants of other North-African and/or European people [ 40 , 41 ]. Nowadays, the approach to compute the normal values using cross-sectional reference equations that include terms for ethnicity/race is of uncertain clinical benefit and may highlight inequalities [ 42 ]. It appears that there is no evidence that ethnic/race-based spirometry norms improved the prediction of clinical events compared to ethnic/race-neutral norms [ 42 ].…”

Section: Discussionmentioning

confidence: 99%

“…Nowadays, the approach to compute the normal values using cross-sectional reference equations that include terms for ethnicity/race is of uncertain clinical benefit and may highlight inequalities [ 42 ]. It appears that there is no evidence that ethnic/race-based spirometry norms improved the prediction of clinical events compared to ethnic/race-neutral norms [ 42 ]. Therefore, the inclusion of ethnicity/race in spirometry norms should be reconsidered [ 42 ].…”

Section: Discussionmentioning

confidence: 99%

“…It appears that there is no evidence that ethnic/race-based spirometry norms improved the prediction of clinical events compared to ethnic/race-neutral norms [ 42 ]. Therefore, the inclusion of ethnicity/race in spirometry norms should be reconsidered [ 42 ]. The second limitation is related to the convenience sampling whose primary weaknesses are the hazard that the sample might not characterize the population as a whole, and the results might propose a bias in the answers from volunteers [ 43 ].…”

Section: Discussionmentioning

confidence: 99%

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The global lung function initiative 2021 (GLI-2021) norms provide mixed results for static lung volumes (SLVs) in Algerian adults

Ketfi

Saad

2022

Libyan Journal of Medicine

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The validity of the GLI-2021 norms for SLVs in healthy Algerian adults has not been assessed. To ascertain how well do the GLI-2021 norms fit to contemporary SLVs data in Algerian adults. This was a cross-sectional study involving 481 (n = 242 females) healthy non-smoking adults recruited from the Algiers general population. All participants underwent a clinical examination and a plethysmography. Z-scores for slow vital capacity (SVC), functional residual capacity (FRC), residual volume (RV), total lung capacity (TLC), expiratory reserve volume (ERV), inspiratory capacity (IC), and RV/TLC were calculated. The mean difference between the determined and the predicted values (∆value) of SLVs were calculated. The GLI-2021 norms would be considered as reflective of contemporary Algerian SLVs if the total sample mean z-scores were in the normal range ( ie ; −0.5 to +0.5). The participants’ means ± SDs of age and height were 46.4 ± 16.4 years and 166 ± 10 cm, respectively. The determined SLVs were significantly different from those predicted (∆values means ± SDs were −170 ± 470 ml for IC, −100 ± 490 ml for SVC, 170 ± 400 ml for ERV, 240 ± 620 ml for TLC, 370 ± 340 ml for RV, 480 ± 480 ml for FRC, and 5.28 ± 4.38% for RV/TLC). The means ± SDs z-scores for IC, SVC, ERV, and TLC were in the normal range (−0.29 ± 0.88, −0.17 ± 0.94, 0.29 ± 0.77, and 0.35 ± 0.86, respectively), but those of RV, FRC, and RV/TLC were out of the normal range (0.74 ± 0.66, 0.75 ± 0.72, and 0.83 ± 0.75, respectively). In healthy Algerian adults, the GLI-2021 norms fit well to SVC, TLC, ERV, and IC, but they do not fit to FRC, RV, and RV/TLC.

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“…Elmaleh-Sachs et al looked at the role of spirometry in the prediction of clinical events for participants enrolled in the Multi-Ethnic Study of Atherosclerosis Lung Study. 37 They found and recommended the following:…”

Section: Spirometry and The Relationship To Racial Inequities In Asth...mentioning

confidence: 99%

Structural Inequities in Medicine that Contribute to Racial Inequities in Asthma Care

Okelo

2022

Semin Respir Crit Care Med

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Structural inequities in medicine have been present for centuries in the United States, but only recently are these being recognized as contributors to racial inequities in asthma care and asthma outcomes. This chapter provides a systematic review of structural factors such as racial bias in spirometry algorithms, the history of systemic racism in medicine, workforce/pipeline limitations to the presence of underrepresented minority health care providers, bias in research funding awards, and strategies to solve these problems.

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Race/Ethnicity, Spirometry Reference Equations, and Prediction of Incident Clinical Events: The Multi-Ethnic Study of Atherosclerosis (MESA) Lung Study

Cited by 66 publications

References 46 publications

Race-specific reference values and lung function impairment, breathlessness and prognosis: Analysis of NHANES 2007–2012

Race-specific reference values and lung function impairment, breathlessness and prognosis: Analysis of NHANES 2007–2012

The global lung function initiative 2021 (GLI-2021) norms provide mixed results for static lung volumes (SLVs) in Algerian adults

Structural Inequities in Medicine that Contribute to Racial Inequities in Asthma Care

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