Comparison of Race-neutral Versus Race-specific Spirometry Equations for Evaluation of Child Asthma.

View Abstract

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.

Investigators
Abbreviation
Am J Respir Crit Care Med
Publication Date
2024-12-06
Pubmed ID
39642347
Medium
Print-Electronic
Full Title
Comparison of Race-neutral Versus Race-specific Spirometry Equations for Evaluation of Child Asthma.
Authors
Non AL, Li X, Jones MR, Oken E, Hartert T, Schoettler N, Gold DR, Ramratnam S, Schauberger EM, Tantisira K, Bacharier LB, Conrad DJ, Carroll KN, Nkoy FL, Luttmann-Gibson H, Gilliland FD, Breton CV, Kattan M, Lemanske RF, Litonjua AA, McEvoy CT, Rivera-Spoljaric K, Rosas-Salazar C, Joseph CLM, Palmore M, Ryan PH, Wegienka G, Sitarik AR, Singh AM, Miller RL, Zoratti EM, Ownby D, Camargo CA, Aschner JL, Stroustrup A, Farzan SF, Karagas MR, Jackson DJ, Gern JE,