TY - JOUR
T1 - Race/Ethnicity, Spirometry Reference Equations, and Prediction of Incident Clinical Events :The Multi-Ethnic Study of Atherosclerosis (MESA) Lung Study
AU - Elmaleh-Sachs, Arielle
AU - Balte, Pallavi
AU - Oelsner, Elizabeth C.
AU - Allen, Norrina B.
AU - Baugh, Aaron
AU - Bertoni, Alain G.
AU - Hankinson, John L.
AU - Pankow, Jim
AU - Post, Wendy S.
AU - Schwartz, Joseph E.
AU - Smith, Benjamin M.
AU - Watson, Karol
AU - Barr, R. Graham
N1 - Funding Information:
Supported by NHLBI grants R01-HL077612, R01-HL093081, and R01-HL130506. Additional support was provided by Health Resources and Services Administration grant T32HP10260. MESA was supported by NHLBI contracts 75N92020D00001, HHSN268201500003I, N01-HC-95159, 75N92020D00005, N01-HC-95160, 75N92020D00002, N01-HC-95161, 75N92020D00003, N01-HC-95162, 75N92020D0006, N01-HC-95163, 75N92020D00004, N01-HC-95164, 75N92020D00007, N01-HC-95165, N01-HC-95166, N01-HC-95167, N01-HC-95168, and N01-HC-95169 and by National Center for Advancing Translational Sciences grants UL1-TR-000040, UL1-TR-001079, and UL1-TR-001420.
Publisher Copyright:
© 2022 by the American Thoracic Society
PY - 2022/3/15
Y1 - 2022/3/15
N2 - Rationale: Normal values for FEV1 and FVC are currently calculated using cross-sectional reference equations that include terms for race/ethnicity, an approach that may reinforce disparities and is of unclear clinical benefit. Objectives: To determine whether race/ethnicity–based spirometry reference equations improve the prediction of incident chronic lower respiratory disease (CLRD) events and mortality compared with race/ethnicity–neutral equations. Methods: The MESA Lung Study, a population-based, prospective cohort study of White, Black, Hispanic, and Asian adults, performed standardized spirometry from 2004 to 2006. Predicted values for spirometry were calculated using race/ ethnicity–based equations following guidelines and, alternatively, race/ethnicity–neutral equations without terms for race/ethnicity. Participants were followed for events through 2019. Measurements and Main Results: The mean age of 3,344 participants was 65 years, and self-reported race/ethnicity was 36% White, 25% Black, 23% Hispanic, and 17% Asian. There were 181 incident CLRD-related events and 547 deaths over a median of 11.6 years. There was no evidence that percentage predicted FEV1 or FVC calculated using race/ethnicity–based equations improved the prediction of CLRD-related events compared with those calculated using race/ethnicity–neutral equations (difference in C statistics for FEV1, 20.005; 95% confidence interval [CI], 20.013 to 0.003; difference in C statistic for FVC, 20.008; 95% CI, 20.016 to 20.0006). Findings were similar for mortality (difference in C statistics for FEV1, 20.002; 95% CI, 20.008 to 0.003; difference in C statistics for FVC, 20.004; 95% CI, 20.009 to 0.001). Conclusions: There was no evidence that race/ethnicity–based spirometry reference equations improved the prediction of clinical events compared with race/ethnicity–neutral equations. The inclusion of race/ethnicity in spirometry reference equations should be reconsidered.
AB - Rationale: Normal values for FEV1 and FVC are currently calculated using cross-sectional reference equations that include terms for race/ethnicity, an approach that may reinforce disparities and is of unclear clinical benefit. Objectives: To determine whether race/ethnicity–based spirometry reference equations improve the prediction of incident chronic lower respiratory disease (CLRD) events and mortality compared with race/ethnicity–neutral equations. Methods: The MESA Lung Study, a population-based, prospective cohort study of White, Black, Hispanic, and Asian adults, performed standardized spirometry from 2004 to 2006. Predicted values for spirometry were calculated using race/ ethnicity–based equations following guidelines and, alternatively, race/ethnicity–neutral equations without terms for race/ethnicity. Participants were followed for events through 2019. Measurements and Main Results: The mean age of 3,344 participants was 65 years, and self-reported race/ethnicity was 36% White, 25% Black, 23% Hispanic, and 17% Asian. There were 181 incident CLRD-related events and 547 deaths over a median of 11.6 years. There was no evidence that percentage predicted FEV1 or FVC calculated using race/ethnicity–based equations improved the prediction of CLRD-related events compared with those calculated using race/ethnicity–neutral equations (difference in C statistics for FEV1, 20.005; 95% confidence interval [CI], 20.013 to 0.003; difference in C statistic for FVC, 20.008; 95% CI, 20.016 to 20.0006). Findings were similar for mortality (difference in C statistics for FEV1, 20.002; 95% CI, 20.008 to 0.003; difference in C statistics for FVC, 20.004; 95% CI, 20.009 to 0.001). Conclusions: There was no evidence that race/ethnicity–based spirometry reference equations improved the prediction of clinical events compared with race/ethnicity–neutral equations. The inclusion of race/ethnicity in spirometry reference equations should be reconsidered.
KW - chronic lower respiratory disease
KW - pulmonary function tests
KW - race/ethnicity–based reference equations
KW - racism
KW - spirometry
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U2 - 10.1164/RCCM.202107-1612OC
DO - 10.1164/RCCM.202107-1612OC
M3 - Article
C2 - 34913853
AN - SCOPUS:85126830678
SN - 1073-449X
VL - 205
SP - 700
EP - 710
JO - American Review of Respiratory Disease
JF - American Review of Respiratory Disease
IS - 6
ER -