A Race-neutral Approach to the Interpretation of Lung Function Measurements

The use of self-reported race and ethnicity to interpret lung function measurements has historically assumed that the observed differences in lung function between racial and ethnic groups were because of thoracic cavity size differences relative to standing height. Very few studies have considered...

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Published in:	American journal of respiratory and critical care medicine Vol. 207; no. 6; p. 768
Main Authors:	Bowerman, Cole, Bhakta, Nirav R, Brazzale, Danny, Cooper, Brendan R, Cooper, Julie, Gochicoa-Rangel, Laura, Haynes, Jeffrey, Kaminsky, David A, Lan, Le Thi Tuyet, Masekela, Refiloe, McCormack, Meredith C, Steenbruggen, Irene, Stanojevic, Sanja
Format:	Journal Article
Language:	English
Published:	United States 15.03.2023
Subjects:	Ethnicity Forced Expiratory Volume Humans Lung Nutrition Surveys Reference Values Spirometry Vital Capacity health equity spirometry racial groups
ISSN:	1535-4970, 1535-4970
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Abstract	The use of self-reported race and ethnicity to interpret lung function measurements has historically assumed that the observed differences in lung function between racial and ethnic groups were because of thoracic cavity size differences relative to standing height. Very few studies have considered the influence of environmental and social determinants on pulmonary function. Consequently, the use of race and ethnicity-specific reference equations may further marginalize disadvantaged populations. To develop a race-neutral reference equation for spirometry interpretation. National Health and Nutrition Examination Survey (NHANES) III data ( = 6,984) were reanalyzed with sitting height and the Cormic index to investigate whether body proportions were better predictors of lung function than race and ethnicity. Furthermore, the original GLI (Global Lung Function Initiative) data ( = 74,185) were reanalyzed with inverse-probability weights to create race-neutral GLI global (2022) equations. The inclusion of sitting height slightly improved the statistical precision of reference equations compared with using standing height alone but did not explain observed differences in spirometry between the NHANES III race and ethnic groups. GLI global (2022) equations, which do not require the selection of race and ethnicity, had a similar fit to the GLI 2012 "other" equations and wider limits of normal. The use of a single global spirometry equation reflects the wide range of lung function observed within and between populations. Given the inherent limitations of any reference equation, the use of GLI global equations to interpret spirometry requires careful consideration of an individual's symptoms and medical history when used to make clinical, employment, and insurance decisions.
AbstractList	Rationale: The use of self-reported race and ethnicity to interpret lung function measurements has historically assumed that the observed differences in lung function between racial and ethnic groups were because of thoracic cavity size differences relative to standing height. Very few studies have considered the influence of environmental and social determinants on pulmonary function. Consequently, the use of race and ethnicity-specific reference equations may further marginalize disadvantaged populations. Objectives: To develop a race-neutral reference equation for spirometry interpretation. Methods: National Health and Nutrition Examination Survey (NHANES) III data (n = 6,984) were reanalyzed with sitting height and the Cormic index to investigate whether body proportions were better predictors of lung function than race and ethnicity. Furthermore, the original GLI (Global Lung Function Initiative) data (n = 74,185) were reanalyzed with inverse-probability weights to create race-neutral GLI global (2022) equations. Measurements and Main Results: The inclusion of sitting height slightly improved the statistical precision of reference equations compared with using standing height alone but did not explain observed differences in spirometry between the NHANES III race and ethnic groups. GLI global (2022) equations, which do not require the selection of race and ethnicity, had a similar fit to the GLI 2012 "other" equations and wider limits of normal. Conclusions: The use of a single global spirometry equation reflects the wide range of lung function observed within and between populations. Given the inherent limitations of any reference equation, the use of GLI global equations to interpret spirometry requires careful consideration of an individual's symptoms and medical history when used to make clinical, employment, and insurance decisions.Rationale: The use of self-reported race and ethnicity to interpret lung function measurements has historically assumed that the observed differences in lung function between racial and ethnic groups were because of thoracic cavity size differences relative to standing height. Very few studies have considered the influence of environmental and social determinants on pulmonary function. Consequently, the use of race and ethnicity-specific reference equations may further marginalize disadvantaged populations. Objectives: To develop a race-neutral reference equation for spirometry interpretation. Methods: National Health and Nutrition Examination Survey (NHANES) III data (n = 6,984) were reanalyzed with sitting height and the Cormic index to investigate whether body proportions were better predictors of lung function than race and ethnicity. Furthermore, the original GLI (Global Lung Function Initiative) data (n = 74,185) were reanalyzed with inverse-probability weights to create race-neutral GLI global (2022) equations. Measurements and Main Results: The inclusion of sitting height slightly improved the statistical precision of reference equations compared with using standing height alone but did not explain observed differences in spirometry between the NHANES III race and ethnic groups. GLI global (2022) equations, which do not require the selection of race and ethnicity, had a similar fit to the GLI 2012 "other" equations and wider limits of normal. Conclusions: The use of a single global spirometry equation reflects the wide range of lung function observed within and between populations. Given the inherent limitations of any reference equation, the use of GLI global equations to interpret spirometry requires careful consideration of an individual's symptoms and medical history when used to make clinical, employment, and insurance decisions. The use of self-reported race and ethnicity to interpret lung function measurements has historically assumed that the observed differences in lung function between racial and ethnic groups were because of thoracic cavity size differences relative to standing height. Very few studies have considered the influence of environmental and social determinants on pulmonary function. Consequently, the use of race and ethnicity-specific reference equations may further marginalize disadvantaged populations. To develop a race-neutral reference equation for spirometry interpretation. National Health and Nutrition Examination Survey (NHANES) III data ( = 6,984) were reanalyzed with sitting height and the Cormic index to investigate whether body proportions were better predictors of lung function than race and ethnicity. Furthermore, the original GLI (Global Lung Function Initiative) data ( = 74,185) were reanalyzed with inverse-probability weights to create race-neutral GLI global (2022) equations. The inclusion of sitting height slightly improved the statistical precision of reference equations compared with using standing height alone but did not explain observed differences in spirometry between the NHANES III race and ethnic groups. GLI global (2022) equations, which do not require the selection of race and ethnicity, had a similar fit to the GLI 2012 "other" equations and wider limits of normal. The use of a single global spirometry equation reflects the wide range of lung function observed within and between populations. Given the inherent limitations of any reference equation, the use of GLI global equations to interpret spirometry requires careful consideration of an individual's symptoms and medical history when used to make clinical, employment, and insurance decisions.
Author	Masekela, Refiloe Steenbruggen, Irene Gochicoa-Rangel, Laura Kaminsky, David A Bowerman, Cole Haynes, Jeffrey Lan, Le Thi Tuyet Stanojevic, Sanja Cooper, Brendan R Cooper, Julie McCormack, Meredith C Bhakta, Nirav R Brazzale, Danny
Author_xml	– sequence: 1 givenname: Cole orcidid: 0000-0002-9871-281X surname: Bowerman fullname: Bowerman, Cole organization: Department of Community Health and Epidemiology, Dalhousie University, Halifax, Nova Scotia, Canada – sequence: 2 givenname: Nirav R surname: Bhakta fullname: Bhakta, Nirav R organization: Pulmonary, Critical Care, Allergy, and Sleep Medicine, University of California San Francisco, San Francisco, California – sequence: 3 givenname: Danny surname: Brazzale fullname: Brazzale, Danny organization: Department of Respiratory and Sleep Medicine, Austin Hospital, Heidelberg, Germany – sequence: 4 givenname: Brendan R surname: Cooper fullname: Cooper, Brendan R organization: Lung Function & Sleep, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom – sequence: 5 givenname: Julie surname: Cooper fullname: Cooper, Julie organization: Lung Function & Sleep, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom – sequence: 6 givenname: Laura orcidid: 0000-0003-3009-5867 surname: Gochicoa-Rangel fullname: Gochicoa-Rangel, Laura organization: Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas, Mexico City, Mexico – sequence: 7 givenname: Jeffrey surname: Haynes fullname: Haynes, Jeffrey organization: Pulmonary Function Laboratory, Elliot Health System, Manchester, New Hampshire – sequence: 8 givenname: David A surname: Kaminsky fullname: Kaminsky, David A organization: Pulmonary Disease and Critical Care Medicine, University of Vermont College of Medicine, Burlington, Vermont – sequence: 9 givenname: Le Thi Tuyet surname: Lan fullname: Lan, Le Thi Tuyet organization: University of Medicine and Pharmacy, Ho Chi Minh City, Vietnam – sequence: 10 givenname: Refiloe orcidid: 0000-0001-9665-2035 surname: Masekela fullname: Masekela, Refiloe organization: Department of Paediatrics and Child Health, Faculty of Health Sciences, School of Clinical Medicine, University of Kwazulu-Natal, Durban, South Africa – sequence: 11 givenname: Meredith C orcidid: 0000-0003-1702-3201 surname: McCormack fullname: McCormack, Meredith C organization: Division of Pulmonary and Critical Care, Johns Hopkins School of Medicine, Baltimore, Maryland; and – sequence: 12 givenname: Irene surname: Steenbruggen fullname: Steenbruggen, Irene organization: Pulmonary Function Unit, Isala Hospital, Zwolle, the Netherlands – sequence: 13 givenname: Sanja orcidid: 0000-0001-7931-8051 surname: Stanojevic fullname: Stanojevic, Sanja organization: Department of Community Health and Epidemiology, Dalhousie University, Halifax, Nova Scotia, Canada
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Title	A Race-neutral Approach to the Interpretation of Lung Function Measurements
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