Removing Race-Based Equations for Calculation of Lung Function Increased Number of Abnormal Tests in Black Children

June 17, 2024
New race-neutral equations, established in 2022, follow prevailing wisdom that race does not have any exclusive biological basis.

A new study demonstrated that “removing a race-based adjustment from the calculation of lung function by spirometry in children significantly increased the number of abnormal tests in Black children, including tests suggesting obstructive lung disease.” VUMC's website has the release.

These results suggest that adjustments for race in spirometry “resulted in an underreporting – and thus possibly undertreatment – of chronic lung diseases…in Black children.”

Spirometry is a technique that “measures airflow into and out of the lungs, including forced expiratory volume (FEV1), or the air that is exhaled in 1 second, and forced vital capacity (FVC), the full amount of air expelled with effort in a complete breath.” These measures are used to determine if a patient with low pulmonary function has a “restrictive lung disease…or an obstructive lung disease.”

Race-specific reference equations for spirometry were published in 2012 “to account for observed differences in the level of pulmonary function among five identified racial groups.” However, researchers have increasingly come to challenge the notion that race has an “exclusive biological basis,” and race-neutral equations for spirometry were developed in 2022.

When these race-neutral equations were applied, “the number of tests with a normal lung function pattern decreased by 19.5% among Black children and increased by 7.3% among White children compared to when race-based equations” were used. Applying these race-neutral equations “may prompt additional testing or lead to an ‘escalation’ of asthma care that includes the prescription of inhaled corticosteroids.”

About the Author

Matt MacKenzie | Associate Editor

Matt is Associate Editor for Healthcare Purchasing News.