Reconsidering the Utility of Race-Specific Lung Function Prediction Equations

Aaron D Baugh; Stephen Shiboski; Nadia N Hansel; Victor Ortega; Igor Barjakteravic; R Graham Barr; Russell Bowler; Alejandro P Comellas; Christopher B Cooper; David Couper; Gerard Criner; Jeffrey L Curtis; Mark Dransfield; Chinedu Ejike; MeiLan K Han; Eric Hoffman; Jamuna Krishnan; Jerry A Krishnan; David Mannino; Robert Paine III; Trisha Parekh; Stephen Peters; Nirupama Putcha; Stephen Rennard; Neeta Thakur; Prescott G Woodruff

doi:10.1164/rccm.202105-1246OC

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Reconsidering the Utility of Race-Specific Lung Function Prediction Equations

Journal article

Open access

Peer reviewed

Reconsidering the Utility of Race-Specific Lung Function Prediction Equations

Aaron D Baugh, Stephen Shiboski, Nadia N Hansel, Victor Ortega, Igor Barjakteravic, R Graham Barr, Russell Bowler, Alejandro P Comellas, Christopher B Cooper, David Couper, …

American journal of respiratory and critical care medicine, Vol.205(7), pp.819-829

04/01/2022

DOI: 10.1164/rccm.202105-1246OC

PMCID: PMC9836221

PMID: 34913855

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https://www.ncbi.nlm.nih.gov/pmc/articles/9836221View

Open Access

Abstract

African American individuals have worse outcomes in chronic obstructive pulmonary disease (COPD). To assess whether race-specific approaches for estimating lung function contribute to racial inequities by failing to recognize pathological decrements and considering them normal. In a cohort with and at risk for COPD, we assessed whether lung function prediction equations applied in a race-specific versus universal manner better modeled the relationship between FEV , FVC, and other COPD outcomes, including the COPD Assessment Test, St. George's Respiratory Questionnaire, computed tomography percent emphysema, airway wall thickness, and 6-minute-walk test. We related these outcomes to differences in FEV using multiple linear regression and compared predictive performance between fitted models using root mean squared error and Alpaydin's paired test. Using race-specific equations, African American individuals were calculated to have better lung function than non-Hispanic White individuals (FEV , 76.8% vs. 71.8% predicted; = 0.02). Using universally applied equations, African American individuals were calculated to have worse lung function. Using Hankinson's Non-Hispanic White equation, FEV was 64.7% versus 71.8% ( < 0.001). Using the Global Lung Initiative's Other race equation, FEV was 70.0% versus 77.9% ( < 0.001). Prediction errors from linear regression were less for universally applied equations compared with race-specific equations when examining FEV % predicted with the COPD Assessment Test ( < 0.01), St. George's Respiratory Questionnaire ( < 0.01), and airway wall thickness ( < 0.01). Although African American participants had greater adversity ( < 0.001), less adversity was only associated with better FEV in non-Hispanic White participants ( for interaction = 0.041). Race-specific equations may underestimate COPD severity in African American individuals.Clinical trial registered with www.clinicaltrials.gov (NCT01969344).

Forced Expiratory Volume

Humans

Lung - diagnostic imaging

Pulmonary Disease, Chronic Obstructive

Pulmonary Emphysema

Respiratory Function Tests

Vital Capacity

Details

Title: Subtitle: Reconsidering the Utility of Race-Specific Lung Function Prediction Equations
Creators: Aaron D Baugh - University of California, San Francisco
Stephen Shiboski - University of California, San Francisco
Nadia N Hansel - Johns Hopkins University
Victor Ortega - Wake Forest University
Igor Barjakteravic - University of California System
R Graham Barr - Columbia University
Russell Bowler - National Jewish Health
Alejandro P Comellas - University of Iowa
Christopher B Cooper - Ronald Reagan UCLA Medical Center
David Couper - University of North Carolina at Chapel Hill
Gerard Criner - Temple University Hospital
Jeffrey L Curtis - University of Michigan–Ann Arbor
Mark Dransfield - University of Alabama at Birmingham
Chinedu Ejike - Johns Hopkins University
MeiLan K Han - University of Michigan
Eric Hoffman - University of Iowa
Jamuna Krishnan - Cornell University
Jerry A Krishnan - University of Illinois Chicago
David Mannino - GlaxoSmithKline (Sweden)
Robert Paine III
Trisha Parekh - University of Alabama at Birmingham
Stephen Peters - Wake Forest University
Nirupama Putcha - Johns Hopkins Medicine
Stephen Rennard - University of Nebraska at Omaha
Neeta Thakur - University of California, San Francisco
Prescott G Woodruff - University of California, San Francisco
Resource Type: Journal article
Publication Details: American journal of respiratory and critical care medicine, Vol.205(7), pp.819-829
DOI: 10.1164/rccm.202105-1246OC
PMID: 34913855
PMCID: PMC9836221
NLM abbreviation: Am J Respir Crit Care Med
ISSN: 1073-449X
eISSN: 1535-4970
Grant note: HHSN268200900017C / NHLBI NIH HHS K24HL137013 / NHLBI NIH HHS HHSN268200900019C / NHLBI NIH HHS HHSN268200900020C / NHLBI NIH HHS U24 HL141762 / NHLBI NIH HHS HHSN268200900015C / NHLBI NIH HHS HHSN268200900013C / NHLBI NIH HHS U01HL137880 / NHLBI NIH HHS HHSN268200900016C / NHLBI NIH HHS HHSN268200900018C / NHLBI NIH HHS HL137013 / NHLBI NIH HHS HHSN268200900014C / NHLBI NIH HHS F32HL158160 / NHLBI NIH HHS K23HL125551 / NHLBI NIH HHS P30 DK054759 / NIDDK NIH HHS
Language: English
Date published: 04/01/2022
Academic Unit: Roy J. Carver Department of Biomedical Engineering; Radiology; Pulmonary, Critical Care, and Occupational Medicine; ICTS; Internal Medicine
Record Identifier: 9984318724702771

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