Reconsidering the Utility of Race-Specific Lung Function Prediction Equations

• DOI: 10.1164/rccm.202105-1246oc
• Publication Date: 2021-12-16T15:22:19Z
• Authors: Aaron D. Baugh; Stephen Shiboski; Nadia N. Hansel; Victor Ortega; Igor Barjaktarevic; R. Graham Barr; Russell Bowler; Alejandro P. Come...; Christopher B. Co...; David Couper; Gerard Criner; Jeffrey L. Curtis; Mark Dransfield; Chinedu Ejike; MeiLan K. Han; Eric Hoffman; Jamuna Krishnan; Jerry A. Krishnan; David Mannino; Robert Paine; Trisha Parekh; Stephen Peters; Nirupama Putcha; Stephen Rennard; Neeta Thakur; Prescott G. Woodruff
• Keywords: Chronic Obstructive; Chronic Obstructive Pulmonary Disease; Respiratory System; Vital Capacity; 610; Clinical sciences; Medical and Health Sciences; Cardiovascular medicine and haematology; chronic obstructive pulmonary disease; Pulmonary Disease; Pulmonary Disease, Chronic Obstructive; 03 medical and health sciences; 0302 clinical medicine; Clinical Research; Forced Expiratory Volume; Humans; Minority Health; racism; Lung; health disparities; Biomedical and Clinical Sciences; respiratory function tests; Paediatrics; Respiratory Function Tests; 3. Good health; Health Disparities; Pulmonary Emphysema; Respiratory

Rationale: African American individuals have worse outcomes in chronic obstructive pulmonary disease (COPD). Objectives: To assess whether race-specific approaches for estimating lung function contribute to racial inequities by failing to recognize pathological decrements and considering them normal. Methods: In a cohort with and at risk for COPD, we assessed whether lung function prediction equations applied in a race-specific versus universal manner better modeled the relationship between FEV1, FVC, and other COPD outcomes, including the COPD Assessment Test, St. George's Respiratory Questionnaire, computed tomography percent emphysema, airway wall thickness, and 6-minute-walk test. We related these outcomes to differences in FEV1 using multiple linear regression and compared predictive performance between fitted models using root mean squared error and Alpaydin's paired F test. Measurements and Main Results: Using race-specific equations, African American individuals were calculated to have better lung function than non-Hispanic White individuals (FEV1, 76.8% vs. 71.8% predicted; P = 0.02). Using universally applied equations, African American individuals were calculated to have worse lung function. Using Hankinson's Non-Hispanic White equation, FEV1 was 64.7% versus 71.8% (P < 0.001). Using the Global Lung Initiative's Other race equation, FEV1 was 70.0% versus 77.9% (P < 0.001). Prediction errors from linear regression were less for universally applied equations compared with race-specific equations when examining FEV1% predicted with the COPD Assessment Test (P < 0.01), St. George's Respiratory Questionnaire (P < 0.01), and airway wall thickness (P < 0.01). Although African American participants had greater adversity (P < 0.001), less adversity was only associated with better FEV1 in non-Hispanic White participants (P for interaction = 0.041). Conclusions: Race-specific equations may underestimate COPD severity in African American individuals.Clinical trial registered with www.clinicaltrials.gov (NCT01969344).