Journal article
Early Evidence of COPD Obscured by Race-Specific Prediction Equations
American journal of respiratory and critical care medicine, Vol.209(1), pp.59-69
01/2024
DOI: 10.1164/rccm.202303-0444OC
PMCID: PMC10870894
PMID: 37611073
Abstract
Rationale: Identification of early COPD is essential to appropriately counsel patients regarding smoking cessation, provide symptomatic treatment and eventually develop disease-modifying treatments. Disease severity in COPD is defined with race-specific spirometry equations. These may disadvantage non-white individuals in diagnosis and care. Objectives: Determine impact of race-specific equations on African-American (AA) versus non-Hispanic White (NHW) individuals. Methods: Cross-sectional analyses of the COPDGene cohort comparing NHW (N=6766) and AA (N=3366) participants for COPD manifestations. Measurements: Spirometric classifications using race-specific, multi-ethnic and race-reversed prediction equations [National Health and Nutrition Examination Survey (NHANES) and Global Lung Function Initiative (GLI) “Other and Global”] were compared, as were respiratory symptoms, six-minute walk distance (6MWD), CT imaging, respiratory exacerbations, and St. George’s Respiratory Questionnaire (SGRQ). Main Results: Application of different prediction equations to the cohort resulted in different classifications by stage, with NHANES and GLI race-specific equations being minimally different, but “race-reversed” equations moving AA to more severe stages and especially between the GOLD 0 and preserved ratio impaired spirometry (PRISm) groups. Classification using the established NHANES race-specific equations demonstrated that for each GOLD stage 1-4, AA participants were younger, had fewer pack years and more current smoking, but had more exacerbations, lower 6MWD, greater dyspnea and worse BODE scores and SGRQ scores. Differences were greatest in GOLD 1 and 2 stages. Race-reversed equations reclassified 774 AA (43%) from GOLD 0 to PRISm. Conclusions: Race-specific equations underestimate disease severity among AAs. These effects are particularly evident in early disease and may result in late detection of COPD.
Details
- Title: Subtitle
- Early Evidence of COPD Obscured by Race-Specific Prediction Equations
- Creators
- Elizabeth A Regan - National Jewish HealthMelissa E. Lowe - Duke Comprehensive Cancer Center, 14409, Biostatistics, Durham, North Carolina, United StatesBarry J. Make - National Jewish HealthJeffrey L Curtis - Michigan MedicineQuan (Grace) Chen - Edwards LifesciencesJames L Crooks - National Jewish HealthCarla Wilson - National Jewish HealthGabriela R Oates - University of Alabama at BirminghamRobert W Gregg - University of FloridaArianne K. Baldomero - Minneapolis VA Health Care SystemSurya P Bhatt - University of Alabama at BirminghamAlejandro A Diaz - Brigham and Women's HospitalPanayiotis V Benos - University of FloridaJames K O'Brien - National Jewish HealthKendra A Young - Colorado School of Public HealthGregory L. Kinney - Colorado School of Public HealthDouglas J Conrad - University of California, San DiegoKatherine E Lowe - Case Western Reserve UniversityDawn L DeMeo - Brigham and Women's HospitalAmy Non - University of California, San DiegoMichael H Cho - Brigham and Women's HospitalJulia Kallet - National Jewish HealthMarilyn G Foreman - Morehouse School of MedicineGloria E Westney - Morehouse School of MedicineKarin Hoth - University of IowaNeil R MacIntyre - Duke University HospitalNicola Hanania - Baylor College of MedicineAmy Wolfe - Louisiana State University Health Sciences Center New OrleansHannatu Amaza - University of IowaMeiLan Han - University of Michigan–Ann ArborTerri H. Beaty - Johns Hopkins UniversityNadia N Hansel - Johns Hopkins MedicineMeredith C McCormack - Johns Hopkins MedicineAparna Balasubramanian - Johns Hopkins MedicineJames D Crapo - National Jewish HealthEdwin K Silverman - Brigham and Women's HospitalRichard Casaburi - The Lundquist Institute, 117316, Torrance, California, United StatesRobert A. Wise - Johns Hopkins Medicine
- Resource Type
- Journal article
- Publication Details
- American journal of respiratory and critical care medicine, Vol.209(1), pp.59-69
- DOI
- 10.1164/rccm.202303-0444OC
- PMID
- 37611073
- PMCID
- PMC10870894
- ISSN
- 1073-449X
- eISSN
- 1535-4970
- Grant note
- DOI: 10.13039/100000050, name: National Heart, Lung, and Blood Institute, award: U01 HL089897, U01 HL089856, R01 HL159805, R01 HL157879; DOI: 10.13039/100000050, name: COPD Foundation
- Language
- English
- Electronic publication date
- 08/23/2023
- Date published
- 01/2024
- Academic Unit
- Psychiatry; Iowa Neuroscience Institute; Internal Medicine
- Record Identifier
- 9984459409302771
Metrics
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