More Justification to Eliminate Race Adjustments in Spirometry

In a recent publication, researchers demonstrated that race-based correction factors for spirometry measurements could lead to underdiagnosing restrictive lung disease in Black patients (NEJM JW Gen Med May 1 2022 and Am J Respir Crit Care Med 2022; 205:700). Investigators used prospective cohort data for 2674 patients (47% Black) from four U.S. centers to correlate spirometry results — using both race-specific equations and race-neutral equations — with computed tomography (CT)-confirmed emphysema.

Using race-specific prediction equations (i.e., those correcting “normal” lung-volume predictions to be lower in Black patients), imaging-confirmed emphysema among patients with low-normal forced expiratory volume in 1 second (FEV₁; 80%–99% of predicted) was significantly more prevalent in Black men than in white men (16% vs. 4%) and in Black women than in white women (7% vs. 3%). Similarly, imaging-confirmed emphysema among patients with high-normal FEV₁ (100%–120% of predicted) was significantly more prevalent in Black men than in white men (14% vs. 2%) but not significantly different in Black women than in white women (3% vs. 2%). Race-neutral equations mitigated some of the racial differences in emphysema prevalence among men and eliminated racial differences among women.