RATIONALE
Race-based estimates of pulmonary function in children could influence the evaluation of asthma in children from racial and ethnic minoritized backgrounds.
OBJECTIVES
To determine if race-neutral (GLI-Global) versus race-specific (GLI-Race-Specific) reference equations differentially impact spirometry evaluation of childhood asthma.
METHODS
The analysis included 8,719 children aged 5 to <12 years from 27 cohorts across the United States grouped by parent-reported race and ethnicity. We analyzed how the equations affected forced expiratory volume in 1 second (FEV), forced vital capacity (FVC), and FEV/FVC z-scores. We used multivariable logistic models to evaluate associations between z-scores calculated with different equations and asthma diagnosis, emergency department (ED) visits, and hospitalization.
MEASUREMENTS AND MAIN RESULTS
For Black children, the GLI-Global vs. Race-Specific equations estimated significantly lower z-scores for FEV and FVC but similar values for FEV/FVC, thus increasing the proportion of children classified with low FEV by 14%. While both equations yielded strong inverse relationships between FEV and FEV/FVC z-scores and asthma outcomes, these relationships varied across racial and ethnic groups (p<0.05). For any given FEV or FEV/FVC z-score, asthma diagnosis and ED visits were higher among Black and Hispanic versus White children (p<0.05). For FEV, GLI-Global equations estimated asthma outcomes that were more uniform across racial and ethnic groups.
CONCLUSIONS
Parent-reported race and ethnicity influenced relationships between lung function and asthma outcomes. Our data show no advantage to race-specific equations for evaluating childhood asthma, and the potential for race-specific equations to obscure lung impairment in disadvantaged children strongly supports using race-neutral equations.