Elmaleh-Sachs Arielle, Balte Pallavi, Oelsner Elizabeth C, Allen Norrina B, Baugh Aaron, Bertoni Alain G, Hankinson John L, Pankow Jim, Post Wendy S, Schwartz Joseph E, Smith Benjamin M, Watson Karol, Barr R Graham
Department of Medicine and.
Department of Preventive Medicine, Northwestern University School of Medicine, Chicago, Illinois.
Am J Respir Crit Care Med. 2022 Mar 15;205(6):700-710. doi: 10.1164/rccm.202107-1612OC.
Normal values for FEV 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. 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. 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. 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 FEV 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 FEV, -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 FEV, -0.002; 95% CI, -0.008 to 0.003; difference in C statistics for FVC, -0.004; 95% CI, -0.009 to 0.001). 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.
目前，FEV（第一秒用力呼气容积）和FVC（用力肺活量）的正常值是使用包含种族/族裔因素的横断面参考方程来计算的，这种方法可能会加剧差异，且临床益处尚不明确。为了确定与不考虑种族/族裔的方程相比，基于种族/族裔的肺量计参考方程是否能更好地预测慢性下呼吸道疾病（CLRD）事件和死亡率。MESA肺部研究是一项针对白人、黑人、西班牙裔和亚裔成年人的基于人群的前瞻性队列研究，在2004年至2006年期间进行了标准化肺量计检查。肺量计的预测值按照指南使用基于种族/族裔的方程计算，或者使用不包含种族/族裔因素的方程计算。对参与者进行随访直至2019年。3344名参与者的平均年龄为65岁，自我报告的种族/族裔情况为36%白人、25%黑人、23%西班牙裔和17%亚裔。在中位随访11.6年期间，有181例与CLRD相关的事件和547例死亡。没有证据表明，与使用不考虑种族/族裔的方程计算的结果相比，使用基于种族/族裔的方程计算的预计FEV或FVC百分比能更好地预测与CLRD相关的事件（FEV的C统计量差异为-0.005；95%置信区间[CI]，-0.013至0.003；FVC的C统计量差异为-0.008；95%CI，-0.016至-0.0006）。死亡率的结果相似（FEV的C统计量差异为-0.002；95%CI，-0.008至0.003；FVC的C统计量差异为-0.004；95%CI，-0.009至0.001）。没有证据表明，与不考虑种族/族裔的方程相比，基于种族/族裔的肺量计参考方程能更好地预测临床事件。应重新考虑在肺量计参考方程中纳入种族/族裔因素。
