N Engl J Med
ATS 2024: Study finds wide-ranging implications of removing race from lung function estimates
May 23, 2024
According to new research from scientists at Harvard Medical School, the use of race-based and race-neutral equations generated similarly accurate predictions of respiratory outcomes but assigned different disease classifications, occupational eligibility, and disability compensation for millions of persons, with effects diverging according to race. These findings, presented at the annual meeting of the American Thoracic Society and simultaneously published in the New England Journal of Medicine, suggest that adjusting lung function tests to include race likely normalized worse lung function and downplayed disease severity among Black patients.
Researchers examined longitudinal data from 369,077 participants in the National Health and Nutrition Examination Survey, U.K. Biobank, the Multi-Ethnic Study of Atherosclerosis, and the Organ Procurement and Transplantation Network and compared that with the race-based 2012 Global Lung Function Initiative (GLI-2012) equations with race-neutral equations introduced in 2022 (GLI-Global). Measured outcomes included national projections of clinical, occupational, and financial reclassifications; individual lung-allocation scores for transplantation priority; and concordance statistics (C statistics) for clinical prediction tasks.
Among the 249 million persons in the U.S. 6 to 79 years of age who can produce high-quality spirometric results, the use of GLI-Global equations may reclassify ventilatory impairment for 12.5 million persons, medical impairment ratings for 8.16 million, occupational eligibility for 2.28 million, grading of COPD for 2.05 million, and military disability compensation for 413,000.
What are the implications?
These potential changes differed according to race; for example, classifications of nonobstructive ventilatory impairment may change dramatically, increasing 141% (95% confidence interval [CI], 113 to 169) among Black persons and decreasing 69% (95% CI, 63 to 74) among White persons.
The economic implications are significant; for example, annual disability payments may increase by more than $1 billion among Black veterans and decrease by $0.5 billion among White veterans.
Source:
Diao JA, et al. (2024, May 19). N Engl J Med. Implications of Race Adjustment in Lung-Function Equations. https://pubmed.ncbi.nlm.nih.gov/38767252/
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