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Race-Neutral Equations and Pulmonary Function Test Interpretation in Two Pediatric Cohorts.

Authors :
Doumat G
Mehta GD
Espinola JA
Gallegos C
Zhu Z
Mansbach JM
Hasegawa K
Camargo CA Jr
Source :
The Journal of pediatrics [J Pediatr] 2024 Oct; Vol. 273, pp. 114124. Date of Electronic Publication: 2024 May 28.
Publication Year :
2024

Abstract

Objective: To investigate the changes in predicted lung function measurements when using race-neutral equations in children, based upon the new Global Lung Initiative (GLI) reference equations, utilizing a race-neutral approach in interpreting spirometry results compared with the 2012 race-specific GLI equations.<br />Study Design: We analyzed data from 2 multicenter prospective cohorts comprised of healthy children and children with history of severe (requiring hospitalization) bronchiolitis. Spirometry testing was done at the 6-year physical exam, and 677 tests were analyzed using new GLI Global and 2012 GLI equations. We used multivariable logistic regression, adjusted for age, height, and sex, to examine the association of race with the development of new impairment or increased severity (forced expiratory volume in the first second (FEV1) z-score ≤ -1.645) as per 2022 American Thoracic Society (ATS) guidelines.<br />Results: Compared with the race-specific GLI, the race-neutral equation yielded increases in the median forced expiratory volume in the first second and forced vital capacity (FVC) percent predicted in White children but decreases in these two measures in Black children. The prevalence of obstruction increased in White children by 21%, and the prevalence of possible restriction increased in Black children by 222%. Compared with White race, Black race was associated with increased prevalence of new impairments (aOR 7.59; 95%CI, 3.00-19.67; P < .001) and increased severity (aOR 35.40; 95%CI, 4.70-266.40; P = .001). Results were similar across both cohorts.<br />Conclusions: As there are no biological justifications for the inclusion of race in spirometry interpretation, use of race-neutral spirometry reference equations led to an increase in both the prevalence and severity of respiratory impairments among Black children.<br />Competing Interests: Declaration of Competing Interest The study was supported by NIH grants U01 AI087881, R01 AI114552, R01 AI127507, and UH3 OD023253. The content of this manuscript is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. The authors declare no conflicts of interest.<br /> (Copyright © 2024 Elsevier Inc. All rights reserved.)

Details

Language :
English
ISSN :
1097-6833
Volume :
273
Database :
MEDLINE
Journal :
The Journal of pediatrics
Publication Type :
Academic Journal
Accession number :
38815738
Full Text :
https://doi.org/10.1016/j.jpeds.2024.114124