Spirometry Interpretation After Implementation of Race-Neutral Reference Equations in Children
Year: 2025
Type: conference-abstract
Abstract: Starting in 2012, race-specific reference equations have been used to evaluate spirometry in patients aged 3 to 95 years. Since then, many have suggested race-specific lung function references may contribute to discrimination and health disparities and may otherwise be explained by socioeconomic factors and social determinants of health. In 2023, the Global Lung Function Initiative (GLI) published race-neutral reference equations (GLIN). It is unknown how patient spirometry evaluation would change based on the new race-neutral references.Pulmonary function testing (PFT) was analyzed in 24 630 children aged 6 to 21 years who were seen at the PFT laboratories at 2 large academic medical centers. The study population was 15.6% Black, 79.2% white, and 5.2% other race.Both GLI race-specific (GLIR) and race-neutral (GLIN) equations were used to calculate forced expiratory volume in 1 second (FEV1), forced vital capacity (FVC), ratio of FEV1/FVC z scores and percent predicted values (PPV). Differences in z scores were calculated between GLIR and GLIN, then grouped into 6 spirometry patterns (normal, obstructive, suspected restrictive, mixed, suspected dysanapsis, and uncategorized). The groups were compared using 2-sided paired t tests, linear regression models, and the McNemar paired test.Using the GLIN, there were a statistically significant differences in FEV1, FVC, and FEV1/FVC when compared with the GLIR. FEV1 and FVC decreased, with increases in FEV1/FVC z scores among Black children. In white children, FEV1 and FVC increased with a decrease in FEV1/FVC. Other races mirrored trends of the Black children with smaller differences in z scores, though still significant. With the new GLIN, spirometry patterns changed in 19.5% of Black children, and with normal tests changing to restrictive or uncategorized pattern, 59.1% dysanapsis became obstructive. There was a 3-fold higher odds of changing pattern for Black children as compared with white children. 7.3% of white children had spirometry patterns that changed, primarily from restrictive or uncategorized to normal. There was an increase in normal pattern for children of other races, coming from obstructive, dysanapsis, or uncategorized patterns. Among children with asthma, the spirometry pattern changed in 22% of Black children, with a significant decrease in normal pattern and reclassification of nearly all uncategorized patterns into restrictive pattern.Use of race-neutral spirometry reference equations resulted in statistically significant differences in FEV1 and FVC and changes in spirometry pattern as compared with race-specific references, with increases in normal pattern among white children and decreases in normal pattern among Black children. Race-neutral equations may lead to significant differences in asthma and lung disease management among all pediatric patients.Race-specific references for spirometry may be underestimating lung disease in Black children and children of other races and overestimating lung disease in white children. Race-neutral spirometry references may be better at identifying chronic lung diseases in children and lead to the treatment of more children with chronic lung diseases. As a result, more children from minoritized racial and ethnic backgrounds may now be diagnosed with asthma than previously noted in pediatric practices, which is likely to affect the pediatricians’ management.
Source: PEDIATRICS
Authors: Dana Greene, Julie Wang
Language: English
Subfield: Pulmonary and Respiratory Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: bronze
OpenAlex ID: W4416832708
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