Comparison of Race-Neutral versus Race-Specific Spirometry Equations for Evaluation of Child Asthma
Recommended Citation
Non AL, Li X, Jones MR, Oken E, Hartert T, Schoettler N, Gold DR, Ramratnam S, Schauberger EM, Tantisira K, Bacharier LB, Conrad DJ, Carroll KN, Nkoy FL, Luttmann-Gibson H, Gilliland FD, Breton CV, Kattan M, Lemanske RF, Jr., Litonjua AA, McEvoy CT, Rivera-Spoljaric K, Rosas-Salazar C, Joseph CLM, Palmore M, Ryan PH, Wegienka G, Sitarik AR, Singh AM, Miller RL, Zoratti EM, Ownby D, Camargo CA, Jr., Aschner JL, Stroustrup A, Farzan SF, Karagas MR, Jackson DJ, and Gern JE. Comparison of Race-neutral Versus Race-specific Spirometry Equations for Evaluation of Child Asthma. Am J Respir Crit Care Med 2024.
Document Type
Article
Publication Date
3-1-2025
Publication Title
American journal of respiratory and critical care medicine
Abstract
RATIONALE: Race-based estimates of pulmonary function in children could influence the evaluation of asthma in children from racial and ethnic minoritized backgrounds. OBJECTIVES: To determine if race-neutral (GLI-Global) versus race-specific (GLI-Race-Specific) reference equations differentially impact spirometry evaluation of childhood asthma. METHODS: The analysis included 8,719 children aged 5 to <12 years from 27 cohorts across the United States grouped by parent-reported race and ethnicity. We analyzed how the equations affected forced expiratory volume in 1 second (FEV(1)), forced vital capacity (FVC), and FEV(1)/FVC z-scores. We used multivariable logistic models to evaluate associations between z-scores calculated with different equations and asthma diagnosis, emergency department (ED) visits, and hospitalization. MEASUREMENTS AND MAIN RESULTS: For Black children, the GLI-Global vs. Race-Specific equations estimated significantly lower z-scores for FEV(1) and FVC but similar values for FEV(1)/FVC, thus increasing the proportion of children classified with low FEV(1) by 14%. While both equations yielded strong inverse relationships between FEV(1) and FEV(1)/FVC z-scores and asthma outcomes, these relationships varied across racial and ethnic groups (p<0.05). For any given FEV(1) or FEV(1)/FVC z-score, asthma diagnosis and ED visits were higher among Black and Hispanic versus White children (p<0.05). For FEV(1), GLI-Global equations estimated asthma outcomes that were more uniform across racial and ethnic groups. CONCLUSIONS: Parent-reported race and ethnicity influenced relationships between lung function and asthma outcomes. Our data show no advantage to race-specific equations for evaluating childhood asthma, and the potential for race-specific equations to obscure lung impairment in disadvantaged children strongly supports using race-neutral equations.
Medical Subject Headings
Humans; Asthma; Child; Female; Male; Spirometry; Child, Preschool; United States; Forced Expiratory Volume; Black or African American; Hispanic or Latino; White People; Vital Capacity; Cohort Studies; White
PubMed ID
39642347
ePublication
ePub ahead of print
Volume
211
Issue
3
First Page
464
Last Page
476
