Division of Pulmonary and Critical Care Medicine, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois (G.Y.L., D.M., P.H.S.S.).
Division of Cardiology, Department of Medicine, and Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois (S.S.K.).
Ann Intern Med. 2022 Aug;175(8):1118-1125. doi: 10.7326/M22-0205. Epub 2022 Jul 19.
Computed tomography (CT) imaging complements spirometry and may provide insight into racial disparities in respiratory health.
To determine the difference in emphysema prevalence between Black and White adults with different measures of normal spirometry results.
Observational study using clinical data and spirometry from the CARDIA (Coronary Artery Risk Development in Young Adults) study obtained in 2015 to 2016 and CT scans done in 2010 to 2011.
4 U.S. centers.
Population-based sample of Black and White adults.
Self-identified race and visually identified emphysema on CT in participants with different measures of "normal" spirometry results, calculated using standard race-specific and race-neutral reference equations.
A total of 2674 participants (485 Black men, 762 Black women, 659 White men, and 768 White women) had both a CT scan and spirometry available for analysis. Among participants with a race-specific FEV between 80% and 99% of predicted, 6.5% had emphysema. In this group, emphysema prevalence was 3.9-fold (95% CI, 2.1- to 7.1-fold; 15.5% vs. 4.0%) higher among Black men than White men and 1.9-fold (CI, 1.0- to 3.8-fold; 6.6% vs. 3.4%) higher among Black women than White women. Among participants with a race-specific FEV between 100% and 120% of predicted, 4.0% had emphysema. In this category, Black men had a 6.4-fold (CI, 2.2- to 18.7-fold; 13.9% vs. 2.2%) higher prevalence of emphysema than White men, whereas Black and White women had a similar prevalence of emphysema (2.6% and 2.0%, respectively). The use of race-neutral equations to identify participants with an FEV percent predicted between 80% and 120% attenuated racial differences in emphysema prevalence among men and eliminated racial differences among women.
No CT scans were obtained during the most recent study visit (2015 to 2016) when spirometry was done.
Emphysema is often present before spirometry findings become abnormal, particularly among Black men. Reliance on spirometry alone to differentiate lung health from lung disease may result in the underrecognition of impaired respiratory health and exacerbate racial disparities.
National Institutes of Health.
计算机断层扫描（CT）成像可补充肺活量测定，并可能深入了解呼吸健康方面的种族差异。
确定黑人与白人成年人之间肺气肿患病率的差异，这些成年人的肺活量测定结果存在不同的正常指标。
这是一项观察性研究，使用 2015 年至 2016 年 CARDIA（年轻人冠状动脉风险发展）研究中的临床数据和肺活量测定结果，以及 2010 年至 2011 年的 CT 扫描。
美国 4 个中心。
基于人群的黑人和白人成年人样本。
使用基于种族的标准和非种族标准参考公式计算不同“正常”肺活量测定结果参与者的 CT 上的自我识别种族和视觉识别肺气肿。
共有 2674 名参与者（485 名黑人男性，762 名黑人女性，659 名白人男性和 768 名白人女性）进行了 CT 扫描和肺活量测定分析。在预计值 80%至 99%的 FEV 中具有种族特异性的参与者中，有 6.5%患有肺气肿。在该组中，黑人男性的肺气肿患病率比白人男性高 3.9 倍（95%CI，2.1 至 7.1 倍；15.5%比 4.0%），黑人女性比白人女性高 1.9 倍（95%CI，1.0 至 3.8 倍；6.6%比 3.4%）。在预计值 100%至 120%的 FEV 中具有种族特异性的参与者中，有 4.0%患有肺气肿。在这一类中，黑人男性的肺气肿患病率比白人男性高 6.4 倍（95%CI，2.2 至 18.7 倍；13.9%比 2.2%），而黑人女性和白人女性的肺气肿患病率相似（分别为 2.6%和 2.0%）。使用非种族标准方程来识别 FEV 占预计值 80%至 120%之间的参与者，可减弱男性肺气肿患病率的种族差异，并消除女性的种族差异。
在进行肺活量测定时，最近的研究访问（2015 年至 2016 年）期间没有进行 CT 扫描。
肺气肿通常在肺活量测定结果异常之前就已经存在，尤其是在黑人男性中。仅依靠肺活量测定来区分肺部健康与肺部疾病可能导致对受损呼吸健康的认识不足，并加剧种族差异。
美国国立卫生研究院。
