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

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

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

4 Scopus citations

Abstract

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.

Original languageEnglish (US)
Pages (from-to)700-710
Number of pages11
JournalAmerican journal of respiratory and critical care medicine
Volume205
Issue number6
DOIs
StatePublished - Mar 15 2022

Keywords

  • chronic lower respiratory disease
  • pulmonary function tests
  • race/ethnicity–based reference equations
  • racism
  • spirometry

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine
  • Critical Care and Intensive Care Medicine

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