Department of Public Health Sciences, Henry Ford Health, Detroit, Mich.
Department of Public Health Sciences, Henry Ford Health, Detroit, Mich.
J Allergy Clin Immunol Pract. 2023 Oct;11(10):3097-3106. doi: 10.1016/j.jaip.2023.05.045. Epub 2023 Jun 8.
Race-correction for Black patients is standard practice in spirometry testing. History suggests that these corrections are at least partially a result of racist assumptions regarding lung anatomy among Black individuals, which can potentially lead to less frequent diagnoses of pulmonary diseases in this population.
To evaluate the impact of race-correction in spirometry testing among Black and White preadolescents, and examine the frequency of current asthma symptoms in Black children who were differentially classified depending on whether race-corrected or race-uncorrected reference equations were deployed.
Data from Black and White children who completed a clinical examination at age 10 years from a Detroit-based unselected birth cohort were analyzed. Global Lung Initiative 2012 reference equations were applied to spirometry data using both race-corrected and race-uncorrected (ie, population-average) equations. Abnormal results were defined as values less than the fifth percentile. Asthma symptoms were assessed concurrently using the International Study of Asthma and Allergies in Childhood questionnaire, while asthma control was assessed using the Asthma Control Test.
The impact of race-correction on forced expiratory volume in 1 second (FEV)/forced vital capacity ratio was minimal, but abnormal classification of FEV results more than doubled among Black children when race-uncorrected equations were used (7% vs 18.1%) and were almost 8 times greater based on forced vital capacity classification (1.5% vs 11.4%). More than half of Black children differentially classified on FEV (whose FEV was classified as normal with race-corrected equations but abnormal with race-uncorrected equations) experienced asthma symptoms in the past 12 months (52.6%), which was significantly higher than the percentage of Black children consistently classified as normal (35.5%, P = .049), but similar to that of Black children consistently classified as abnormal using both race-corrected and race-uncorrected equations (62.5%, P = .60). Asthma Control Test scores were not different based on classification.
Race-correction had an extensive impact on spirometry classification in Black children, and differentially classified children had a higher rate of asthma symptoms than children consistently classified as normal. Spirometry reference equations should be reevaluated to be aligned with current scientific perspectives on the use of race in medicine.
在肺活量检测中，对黑人患者进行种族校正已成为标准做法。历史表明，这些校正至少部分是由于黑人个体肺部解剖结构的种族主义假设所致，这可能导致该人群中肺部疾病的诊断频率降低。
评估在黑人和白人青少年中进行肺活量检测时种族校正的影响，并检查根据使用种族校正和非种族校正（即人群平均值）参考方程的差异分类，黑人儿童中当前哮喘症状的频率。
分析了底特律无选择性出生队列中完成 10 岁临床检查的黑人和白人儿童的数据。使用全球肺倡议 2012 年参考方程，同时使用种族校正和非种族校正（即人群平均值）方程对肺活量数据进行分析。异常结果定义为值低于第 5 个百分位数。同时使用国际儿童哮喘和过敏研究问卷评估哮喘症状，使用哮喘控制测试评估哮喘控制。
种族校正对 1 秒用力呼气量（FEV）/用力肺活量比值的影响很小，但当使用非种族校正方程时，黑人儿童的 FEV 异常分类增加了一倍以上（7%对 18.1%），而基于用力肺活量分类的异常分类则几乎增加了 8 倍（1.5%对 11.4%）。在 FEV 上差异分类的黑人儿童中，超过一半（52.6%）在过去 12 个月中经历了哮喘症状（其 FEV 用种族校正方程分类正常，但用非种族校正方程分类异常），明显高于始终用种族校正方程分类正常的黑人儿童的比例（35.5%，P=0.049），但与始终用种族校正和非种族校正方程分类异常的黑人儿童的比例相似（62.5%，P=0.60）。哮喘控制测试评分与分类无关。
种族校正对黑人儿童的肺活量分类有广泛影响，差异分类的儿童哮喘症状发生率高于始终被分类为正常的儿童。应重新评估肺活量参考方程，使其与当前医学中使用种族的科学观点保持一致。
