Removing Structural Racism in Pulmonary Function Testing—Why Nothing Is Ever Easy

Abstract

In an analysis of the clinical implications of race-based pulmonary function tests (PFTs), Bonner et al 1 explored the implications of removing race correction in PFTs. The authors demonstrated significant differences in thoracic surgeons' perceptions of clinical management for a hypothetical African American patient with lung cancer. By using a randomized clinical vignette of an African American woman with lung cancer, the authors demonstrated how treatment recommendations and risk perception would change among thoracic surgeons when interpreting risk for the same patient with a percent predicted postoperative forced expiratory volume in 1 second (FEV 1 ) that was calculated using a standard of care Global Lung Initiative (GLI) race-corrected, GLI other race or multiracial-corrected, or GLI race-neutral equation. 1 With 15 of 16 hospitals in a statewide collaborative reporting using race correction in PFTs for African American patients, the unnecessary use of race in medicine affected 91.8% of African American patients in the statewide collaborative. However, as the authors demonstrate, decorrecting PFT values may result in fewer of these patients qualifying for potentially curative lung resection. Surgeons randomized to assess the percent predicted postoperative FEV 1 race-corrected values were significantly more likely to recommend lobectomy compared with surgeons randomized to the race-neutral equation values.