Race-Specific Spirometry Equations Do Not Improve Models of Dyspnea and Quantitative Chest CT Phenotypes

Non, Amy L.; Bailey, Barbara; Bhatt, Surya P.; Casaburi, Richard; Regan, Elizabeth A.; Wang, Angela Yee-Moon; Limon, Alfonso; Rabay, Chantal; Díaz, Alejandro A.; Baldomero, Arianne K.; Kinney, Gregory L.; Young, Kendra A.; Felts, Ben; Hand, Carol A.; Conrad, Douglas

doi:10.1016/j.chest.2023.07.019

Cited by 9 publications

(5 citation statements)

References 46 publications

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“…To date, the majority of studies examining the impact of implementing GLIN on spirometry interpretation have been conducted in adults. [10][11][12][13][14][15][16] In a study 25 of 163 children with and without controlled asthma in the US, FEV1 PPV changed by approximately 4 and −10 points in Black and White children, respectively, after changing from GLIR to GLIN, which is comparable with our findings. The authors additionally showed that, regardless of asthma control, using GLIN almost doubled the number of Black children with a low FEV1 (defined as an FEV1 < 80 PPV), although the number of White children with a low FEV1 remained unchanged.…”

Section: Discussionsupporting

confidence: 90%

“…To date, the majority of studies examining the impact of implementing GLIN on spirometry interpretation have been conducted in adults . In a study of 163 children with and without controlled asthma in the US, FEV1 PPV changed by approximately 4 and −10 points in Black and White children, respectively, after changing from GLIR to GLIN, which is comparable with our findings.…”

Section: Discussionsupporting

confidence: 87%

“…To our knowledge, no study has examined the clinical implications of using GLIN in the pediatric population. However, studies have shown that in Black adults, the use of GLIN can better predict certain respiratory symptoms in those at risk of chronic lung diseases (such as smokers), 14 change health care clinician recommendations among those requiring surgery for lung cancer, 15 and improve mortality estimation among those from the general population. 16…”

Section: Discussionmentioning

confidence: 99%

“…In addition, GLIN did not include race as a variable and used reweighting of smaller racial subpopulations to achieve better balance in sample sizes. However, the implications of adopting GLIN on spirometry interpretation in children remain unknown, as the few prior studies in this field have been mainly done in adults . We hypothesized that spirometry results and patterns in children would change when transitioning from GLIR to GLIN and that these changes would differ by race.…”

Section: Introductionmentioning

confidence: 98%

“…However, the implications of adopting GLIN on spirometry interpretation in children remain unknown, as the few prior studies in this field have been mainly done in adults. [10][11][12][13][14][15][16] We hypothesized that spirometry results and patterns in children would change when transitioning from GLIR to GLIN and that these changes would differ by race. To test this hypothesis, we performed a cross-sectional study of spirometry tests conducted in children attending the PFT laboratories of 2 large academic pediatric institutions in the US.…”

mentioning

confidence: 99%

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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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