Reconsidering the Utility of Race-Specific Lung Function Prediction Equations.

TitleReconsidering the Utility of Race-Specific Lung Function Prediction Equations.
Publication TypePublication
Year2022
AuthorsBaugh AD, Shiboski S, Hansel NN, Ortega V, Barjaktarevic I, R Barr G, Bowler R, Comellas AP, Cooper CB, Couper D, Criner G, Curtis JL, Dransfield M, Ejike C, Han MK, Hoffman E, Krishnan J, Krishnan JA, Mannino D, Paine R, Parekh T, Peters S, Putcha N, Rennard S, Thakur N, Woodruff PG
JournalAm J Respir Crit Care Med
Volume205
Issue7
Pagination819-829
Date Published2022 Apr 01
ISSN1535-4970
KeywordsForced Expiratory Volume, Humans, Lung, Pulmonary Disease, Chronic Obstructive, Pulmonary Emphysema, Respiratory Function Tests, Vital Capacity
Abstract

African American individuals have worse outcomes in chronic obstructive pulmonary disease (COPD). To assess whether race-specific approaches for estimating lung function contribute to racial inequities by failing to recognize pathological decrements and considering them normal. 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 FEV, 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 FEV using multiple linear regression and compared predictive performance between fitted models using root mean squared error and Alpaydin's paired test. Using race-specific equations, African American individuals were calculated to have better lung function than non-Hispanic White individuals (FEV, 76.8% vs. 71.8% predicted;  = 0.02). Using universally applied equations, African American individuals were calculated to have worse lung function. Using Hankinson's Non-Hispanic White equation, FEV was 64.7% versus 71.8% ( < 0.001). Using the Global Lung Initiative's Other race equation, FEV was 70.0% versus 77.9% ( < 0.001). Prediction errors from linear regression were less for universally applied equations compared with race-specific equations when examining FEV% predicted with the COPD Assessment Test ( < 0.01), St. George's Respiratory Questionnaire ( < 0.01), and airway wall thickness ( < 0.01). Although African American participants had greater adversity ( < 0.001), less adversity was only associated with better FEV in non-Hispanic White participants ( for interaction = 0.041). Race-specific equations may underestimate COPD severity in African American individuals.Clinical trial registered with www.clinicaltrials.gov (NCT01969344).

DOI10.1164/rccm.202105-1246OC
Alternate JournalAm J Respir Crit Care Med
PubMed ID34913855
PubMed Central IDPMC9836221
Grant ListU24 HL141762 / HL / NHLBI NIH HHS / United States
F32 HL158160 / HL / NHLBI NIH HHS / United States
K24HL137013 / HL / NHLBI NIH HHS / United States
HL137013 / HL / NHLBI NIH HHS / United States
F32HL158160 / HL / NHLBI NIH HHS / United States
K23HL125551 / HL / NHLBI NIH HHS / United States
U01HL137880 / HL / NHLBI NIH HHS / United States
P30 DK054759 / DK / NIDDK NIH HHS / United States
MS#: 
MS224
Manuscript Full Title: 
Reconsidering the Utility of Race-Specific Lung Function Prediction Equations.
Manuscript Lead/Corresponding Author Affiliation: 
Clinical Center: San Francisco (University of California at San Francisco)
ECI: 
Manuscript Status: 
Published and Public