Early Evidence of Chronic Obstructive Pulmonary Disease Obscured by Race-Specific Prediction Equations

Regan, Elizabeth A.; Lowe, Melissa E.; Make, Barry J.; Curtis, Jeffrey L.; Chen, Quan (Grace); Crooks, James L.; Wilson, Carla; Oates, Gabriela R.; Gregg, Robert W.; Baldomero, Arianne K.; Bhatt, Surya P.; Diaz, Alejandro A.; Benos, Panayiotis V.; O’Brien, James K.; Young, Kendra A.; Kinney, Gregory L.; Conrad, Douglas J.; Lowe, Katherine E.; DeMeo, Dawn L.; Non, Amy; Cho, Michael H.; Kallet, Julia; Foreman, Marilyn G.; Westney, Gloria E.; Hoth, Karin; MacIntyre, Neil R.; Hanania, Nicola A.; Wolfe, Amy; Amaza, Hannatu; Han, MeiLan; Beaty, Terri H.; Hansel, Nadia N.; McCormack, Meredith C.; Balasubramanian, Aparna; Crapo, James D.; Silverman, Edwin K.; Casaburi, Richard; Wise, Robert A.

doi:10.1164/rccm.202303-0444oc

Cited by 11 publications

(9 citation statements)

References 32 publications

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“…found that using non-Hispanic white reference equations tended to reclassify African Americans in the COPDGene study from the GOLD 0 category into the PRISm category (those with preserved FEV1/FVC but with impaired spirometry as measured by FEV1 percent predicted). 28 We previously noted a greater proportion of African Americans in the airway-predominant trajectories (3–5); given Regan et al.‘s analysis, these proportions may be an underestimate. The factors contributing to proportionally greater representation of African Americans in airway-predominant vs. mixed airway and emphysema trajectories is a fascinating area for further study.…”

Section: Discussionmentioning

confidence: 75%

“…Very recent recommendations call for race-neutral or multiethnic equations to be used until more research can be conducted. 28 , 29 Interestingly, Regan et al. found that using non-Hispanic white reference equations tended to reclassify African Americans in the COPDGene study from the GOLD 0 category into the PRISm category (those with preserved FEV1/FVC but with impaired spirometry as measured by FEV1 percent predicted).…”

Section: Discussionmentioning

confidence: 99%

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Dysanapsis is differentially related to lung function trajectories with distinct structural and functional patterns in COPD and variable risk for adverse outcomes

Ross,

San José Estépar,

Ash

et al. 2024

eClinicalMedicine

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Section: Discussionmentioning

confidence: 75%

Section: Discussionmentioning

confidence: 99%

Dysanapsis is differentially related to lung function trajectories with distinct structural and functional patterns in COPD and variable risk for adverse outcomes

Ross,

San José Estépar,

Ash

et al. 2024

eClinicalMedicine

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“…In recent years, a substantive body of research has demonstrated the bias associated with use of race-specific predictive equations [ 26 , 29 , 34 , 36 ]. As such, we avoided the use of race-specific equations in all our analyses and opted to use Hankinson’s non-Hispanic White predictive equation for all races and the GLI race-neutral predictive equation in a secondary analysis.…”

Section: Discussionmentioning

confidence: 99%

“…We decided against Hankinson’s race-specific equations, which were created and validated for the NHANES III Study, [ 24 ] as there is growing evidence that use of race-specific equations the underestimates the prevalence of COPD across racial groups [ 26 – 29 ].…”

Section: Methodsmentioning

confidence: 99%

“…Given recent debates over the merits of race-specific predicative equations for spirometry, [ 28 , 29 , 34 – 36 ] in addition to Hankinson’s non-Hispanic White predictive equation of lung function, we also applied a race-neutral reference equation to explore differences in COPD prevalence and mortality. We used the Global Lung Function Initiative’s (GLI) race-neutral predictive equation for this secondary analysis [ 35 ].…”

Section: Methodsmentioning

confidence: 99%

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The prevalence and mortality risks of PRISm and COPD in the United States from NHANES 2007–2012

Cadham,

Oh,

Han

et al. 2024

Respir Res

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Background We estimated the prevalence and mortality risks of preserved ratio impaired spirometry (PRISm) and chronic obstructive pulmonary disease (COPD) in the US adult population. Methods We linked three waves of pre-bronchodilator spirometry data from the US National Health and Nutritional Examination Survey (2007–2012) with the National Death Index. The analytic sample included adults ages 20 to 79 without missing data on age, sex, height, BMI, race/ethnicity, and smoking status. We defined COPD (GOLD 1, 2, and 3–4) and PRISm using FEV1/FVC cut points by the Global Initiative for Chronic Obstructive Lung Disease (GOLD). We compared the prevalence of GOLD stages and PRISm by covariates across the three waves. We estimated adjusted all-cause and cause-specific mortality risks by COPD stage and PRISm using all three waves combined. Results Prevalence of COPD and PRISm from 2007–2012 ranged from 13.1%-14.3% and 9.6%-10.2%, respectively. We found significant differences in prevalence by sex, age, smoking status, and race/ethnicity. Males had higher rates of COPD regardless of stage, while females had higher rates of PRISm. COPD prevalence increased with age, but not PRISm, which was highest among middle-aged individuals. Compared to current and never smokers, former smokers showed lower rates of PRISm but higher rates of GOLD 1. COPD prevalence was highest among non-Hispanic White individuals, and PRISm was notably higher among non-Hispanic Black individuals (range 31.4%-37.4%). We found associations between PRISm and all-cause mortality (hazard ratio [HR]: 2.3 95% CI: 1.9—2.9) and various cause-specific deaths (HR ranges: 2.0–5.3). We also found associations between GOLD 2 (HR: 2.1, 95% CI: 1.7–2.6) or higher (HR: 4.2, 95% CI: 2.7–6.5) and all-cause mortality. Cause-specific mortality risk varied within COPD stages but typically increased with higher GOLD stage. Conclusions The prevalence of COPD and PRISm remained stable from 2007–2012. Greater attention should be paid to the potential impacts of PRISm due to its higher prevalence in minority groups and its associations with mortality across various causes including cancer.

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Spirometry Interpretation After Implementation of Race-Neutral Reference Equations in Children

Forno,

Weiner,

Rosas-Salazar

2024

JAMA Pediatr

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ImportanceThe implications of adopting race-neutral reference equations on spirometry interpretation in children remain unknown.ObjectiveTo examine how spirometry results and patterns change when transitioning from Global Lung Function Initiative (GLI) race-specific reference equations (GLIR, 2012) to GLI race-neutral reference equations (GLIN, 2023).Design, Setting, and ParticipantsCross-sectional study of spirometry tests conducted in children aged 6 to 21 years between 2012 and 2022 at 2 large academic pediatric institutions in the US. Data were analyzed from September 2023 to March 2024.ExposuresData on participant characteristics and raw test measurements were collected. Forced expiratory volume in 1 second (FEV1), forced vital capacity (FVC), and FEV1/FVC z scores and percent predicted were calculated using both GLIR and GLIN. In addition, test results were categorized into normal, obstructive, suspected restrictive, mixed, suspected dysanapsis, and uncategorized patterns based on z scores calculated using GLIR or GLIN.Main OutcomesFor each spirometry result, the difference between z scores and percent predicted when transitioning from GLIR to GLIN was calculated. The proportion of tests with a normal pattern and individual spirometry patterns changed by GLI reference equation applied were also examined.ResultsData from 24 630 children were analyzed (mean [SD] age, 12.1 [3.8] years). There were 3848 Black children (15.6%), 19 503 White children (79.2%), and 1279 children of other races (5.2%). Following implementation of GLIN, FEV1 and FVC z scores decreased in Black children (mean difference, −0.814; 95% CI, −0.823 to −0.806; P &lt; .001; and −0.911; 95% CI, −0.921 to −0.902; P &lt; .001, respectively), while FEV1 and FVC z scores slightly increased (0.073; 95% CI, 0.069 to 0.076; P &lt; .001). Similar changes were found when using percent predicted. In Black children, the number of tests with a normal pattern decreased from 2642 (68.7%) to 2383 (61.9%) (χ21 = 204.81; P &lt; .001), mostly due to tests with a normal pattern transitioning to a suspected restrictive or uncategorized pattern. Opposite, albeit smaller, changes in spirometry results and patterns were seen in White children. In adjusted models, Black children had approximately 3-fold higher odds than White children of changing spirometry pattern following the implementation of GLIN (adjusted odds ratio, 3.15; 95% CI, 2.86 to 3.48; P &lt; .001).ConclusionsPronounced differences in spirometry results and patterns were found when switching between GLI reference equations, which markedly differed by race. These findings suggest that the implementation of GLIN is likely to change the treatment of children with chronic lung diseases that are more prevalent in underrepresented minorities, such as asthma.

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Early Evidence of Chronic Obstructive Pulmonary Disease Obscured by Race-Specific Prediction Equations

Cited by 11 publications

References 32 publications

Dysanapsis is differentially related to lung function trajectories with distinct structural and functional patterns in COPD and variable risk for adverse outcomes

Dysanapsis is differentially related to lung function trajectories with distinct structural and functional patterns in COPD and variable risk for adverse outcomes

The prevalence and mortality risks of PRISm and COPD in the United States from NHANES 2007–2012

Spirometry Interpretation After Implementation of Race-Neutral Reference Equations in Children

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