4.7 Article

Race/Ethnicity, Spirometry Reference Equations, and Prediction of Incident Clinical Events The Multi-Ethnic Study of Atherosclerosis (MESA) Lung Study

出版社

AMER THORACIC SOC
DOI: 10.1164/rccm.202107-1612OC

关键词

spirometry; racism; race/ethnicity-based reference equations; chronic lower respiratory disease; pulmonary function tests

资金

  1. NHLBI [75N92020D00001, HHSN268201500003I, N01-HC-95159, 75N92020D00005, N01-HC-95160, 75N92020D00002, N01-HC-95161, 75N92020D00003, N01-HC-95162, 75N92020D0006, N01-HC-95163, 75N92020D00004, N01-HC-95164, 75N92020D00007]
  2. Health Resources and Services Administration [T32HP10260]
  3. National Center for Advancing Translational Sciences [UL1-TR-000040, UL1-TR-001079, UL1-TR-001420]
  4. [N01-HC-95165]
  5. [N01-HC-95166]
  6. [N01-HC-95167]
  7. [N01-HC-95168]
  8. [N01-HC-95169]
  9. [R01-HL077612]
  10. [R01-HL093081]
  11. [R01-HL130506]

向作者/读者索取更多资源

This study found no evidence that race/ethnicity-based spirometry reference equations improved the prediction of CLRD events and mortality compared with race/ethnicity-neutral equations. The inclusion of race/ethnicity in spirometry reference equations should be reconsidered.
Rationale: Normal values for FEV1 and FVC are currently calculated using cross-sectional reference equations that include terms for race/ethnicity, an approach that may reinforce disparities and is of unclear clinical benefit. Objectives: To determine whether race/ethnicity-based spirometry reference equations improve the prediction of incident chronic lower respiratory disease (CLRD) events and mortality compared with race/ethnicity-neutral equations. Methods: The MESA Lung Study, a population-based, prospective cohort study of White, Black, Hispanic, and Asian adults, performed standardized spirometry from 2004 to 2006. Predicted values for spirometry were calculated using race/ethnicity-based equations following guidelines and, alternatively, race/ethnicity-neutral equations without terms for race/ethnicity. Participants were followed for events through 2019. Measurements and Main Results: The mean age of 3,344 participants was 65 years, and self-reported race/ethnicity was 36% White, 25% Black, 23% Hispanic, and 17% Asian. There were 181 incident CLRD-related events and 547 deaths over a median of 11.6 years. There was no evidence that percentage predicted FEV1 or FVC calculated using race/ethnicity-based equations improved the prediction of CLRD-related events compared with those calculated using race/ethnicity-neutral equations (difference in C statistics for FEV1, -0.005; 95% confidence interval [CI], -0.013 to 0.003; difference in C statistic for FVC, -0.008; 95% CI, -0.016 to -0.0006). Findings were similar for mortality (difference in C statistics for FEV1, -0.002; 95% CI, -0.008 to 0.003; difference in C statistics for FVC, -0.004; 95% CI, -0.009 to 0.001). Conclusions: There was no evidence that race/ethnicity-based spirometry reference equations improved the prediction of clinical events compared with race/ethnicity-neutral equations. The inclusion of race/ethnicity in spirometry reference equations should be reconsidered.

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