Race/Ethnicity, Spirometry Reference Equations, and Prediction of Incident Clinical Events :The Multi-Ethnic Study of Atherosclerosis (MESA) Lung Study

Arielle Elmaleh-Sachs; Pallavi Balte; Elizabeth C. Oelsner; Norrina B. Allen; Aaron Baugh; Alain G. Bertoni; John L. Hankinson; Jim Pankow; Wendy S. Post; Joseph E. Schwartz; Benjamin M. Smith; Karol Watson; R. Graham Barr

doi:10.1164/RCCM.202107-1612OC

Race/Ethnicity, Spirometry Reference Equations, and Prediction of Incident Clinical Events :The Multi-Ethnic Study of Atherosclerosis (MESA) Lung Study

Arielle Elmaleh-Sachs, Pallavi Balte, Elizabeth C. Oelsner, Norrina B. Allen, Aaron Baugh, Alain G. Bertoni, John L. Hankinson, Jim Pankow, Wendy S. Post, Joseph E. Schwartz, Benjamin M. Smith, Karol Watson, R. Graham Barr

Epidemiology & Community Health

Research output: Contribution to journal › Article › peer-review

57 Scopus citations

Abstract

Rationale: Normal values for FEV₁ 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. Objectives: 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. Methods: 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. Measurements and Main Results: 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 FEV₁ 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 FEV₁, 20.005; 95% confidence interval [CI], 20.013 to 0.003; difference in C statistic for FVC, 20.008; 95% CI, 20.016 to 20.0006). Findings were similar for mortality (difference in C statistics for FEV₁, 20.002; 95% CI, 20.008 to 0.003; difference in C statistics for FVC, 20.004; 95% CI, 20.009 to 0.001). Conclusions: 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.

Original language	English (US)
Pages (from-to)	700-710
Number of pages	11
Journal	American journal of respiratory and critical care medicine
Volume	205
Issue number	6
DOIs	https://doi.org/10.1164/RCCM.202107-1612OC
State	Published - Mar 15 2022

Bibliographical note

Funding Information:
Supported by NHLBI grants R01-HL077612, R01-HL093081, and R01-HL130506. Additional support was provided by Health Resources and Services Administration grant T32HP10260. MESA was supported by NHLBI contracts 75N92020D00001, HHSN268201500003I, N01-HC-95159, 75N92020D00005, N01-HC-95160, 75N92020D00002, N01-HC-95161, 75N92020D00003, N01-HC-95162, 75N92020D0006, N01-HC-95163, 75N92020D00004, N01-HC-95164, 75N92020D00007, N01-HC-95165, N01-HC-95166, N01-HC-95167, N01-HC-95168, and N01-HC-95169 and by National Center for Advancing Translational Sciences grants UL1-TR-000040, UL1-TR-001079, and UL1-TR-001420.

Publisher Copyright:
© 2022 by the American Thoracic Society

Keywords

chronic lower respiratory disease
pulmonary function tests
race/ethnicity–based reference equations
racism
spirometry

PubMed: MeSH publication types

Journal Article
Research Support, N.I.H., Extramural
Research Support, U.S. Gov't, P.H.S.

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1164/RCCM.202107-1612OC

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Elmaleh-Sachs, A., Balte, P., Oelsner, E. C., Allen, N. B., Baugh, A., Bertoni, A. G., Hankinson, J. L., Pankow, J., Post, W. S., Schwartz, J. E., Smith, B. M., Watson, K., & Barr, R. G. (2022). Race/Ethnicity, Spirometry Reference Equations, and Prediction of Incident Clinical Events :The Multi-Ethnic Study of Atherosclerosis (MESA) Lung Study. American journal of respiratory and critical care medicine, 205(6), 700-710. https://doi.org/10.1164/RCCM.202107-1612OC

Race/Ethnicity, Spirometry Reference Equations, and Prediction of Incident Clinical Events :The Multi-Ethnic Study of Atherosclerosis (MESA) Lung Study. / Elmaleh-Sachs, Arielle; Balte, Pallavi; Oelsner, Elizabeth C. et al.
In: American journal of respiratory and critical care medicine, Vol. 205, No. 6, 15.03.2022, p. 700-710.

Research output: Contribution to journal › Article › peer-review

Elmaleh-Sachs, A, Balte, P, Oelsner, EC, Allen, NB, Baugh, A, Bertoni, AG, Hankinson, JL, Pankow, J, Post, WS, Schwartz, JE, Smith, BM, Watson, K & Barr, RG 2022, 'Race/Ethnicity, Spirometry Reference Equations, and Prediction of Incident Clinical Events :The Multi-Ethnic Study of Atherosclerosis (MESA) Lung Study', American journal of respiratory and critical care medicine, vol. 205, no. 6, pp. 700-710. https://doi.org/10.1164/RCCM.202107-1612OC

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title = "Race/Ethnicity, Spirometry Reference Equations, and Prediction of Incident Clinical Events :The Multi-Ethnic Study of Atherosclerosis (MESA) Lung Study",

abstract = "Rationale: Normal values for FEV1 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. Objectives: 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. Methods: 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. Measurements and Main Results: 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 FEV1 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 FEV1, 20.005; 95% confidence interval [CI], 20.013 to 0.003; difference in C statistic for FVC, 20.008; 95% CI, 20.016 to 20.0006). Findings were similar for mortality (difference in C statistics for FEV1, 20.002; 95% CI, 20.008 to 0.003; difference in C statistics for FVC, 20.004; 95% CI, 20.009 to 0.001). Conclusions: 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.",

keywords = "chronic lower respiratory disease, pulmonary function tests, race/ethnicity–based reference equations, racism, spirometry",

author = "Arielle Elmaleh-Sachs and Pallavi Balte and Oelsner, {Elizabeth C.} and Allen, {Norrina B.} and Aaron Baugh and Bertoni, {Alain G.} and Hankinson, {John L.} and Jim Pankow and Post, {Wendy S.} and Schwartz, {Joseph E.} and Smith, {Benjamin M.} and Karol Watson and Barr, {R. Graham}",

note = "Funding Information: Supported by NHLBI grants R01-HL077612, R01-HL093081, and R01-HL130506. Additional support was provided by Health Resources and Services Administration grant T32HP10260. MESA was supported by NHLBI contracts 75N92020D00001, HHSN268201500003I, N01-HC-95159, 75N92020D00005, N01-HC-95160, 75N92020D00002, N01-HC-95161, 75N92020D00003, N01-HC-95162, 75N92020D0006, N01-HC-95163, 75N92020D00004, N01-HC-95164, 75N92020D00007, N01-HC-95165, N01-HC-95166, N01-HC-95167, N01-HC-95168, and N01-HC-95169 and by National Center for Advancing Translational Sciences grants UL1-TR-000040, UL1-TR-001079, and UL1-TR-001420. Publisher Copyright: {\textcopyright} 2022 by the American Thoracic Society",

year = "2022",

month = mar,

day = "15",

doi = "10.1164/RCCM.202107-1612OC",

language = "English (US)",

volume = "205",

pages = "700--710",

journal = "American journal of respiratory and critical care medicine",

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TY - JOUR

T1 - Race/Ethnicity, Spirometry Reference Equations, and Prediction of Incident Clinical Events :The Multi-Ethnic Study of Atherosclerosis (MESA) Lung Study

AU - Elmaleh-Sachs, Arielle

AU - Balte, Pallavi

AU - Oelsner, Elizabeth C.

AU - Allen, Norrina B.

AU - Baugh, Aaron

AU - Bertoni, Alain G.

AU - Hankinson, John L.

AU - Pankow, Jim

AU - Post, Wendy S.

AU - Schwartz, Joseph E.

AU - Smith, Benjamin M.

AU - Watson, Karol

AU - Barr, R. Graham

N1 - Funding Information: Supported by NHLBI grants R01-HL077612, R01-HL093081, and R01-HL130506. Additional support was provided by Health Resources and Services Administration grant T32HP10260. MESA was supported by NHLBI contracts 75N92020D00001, HHSN268201500003I, N01-HC-95159, 75N92020D00005, N01-HC-95160, 75N92020D00002, N01-HC-95161, 75N92020D00003, N01-HC-95162, 75N92020D0006, N01-HC-95163, 75N92020D00004, N01-HC-95164, 75N92020D00007, N01-HC-95165, N01-HC-95166, N01-HC-95167, N01-HC-95168, and N01-HC-95169 and by National Center for Advancing Translational Sciences grants UL1-TR-000040, UL1-TR-001079, and UL1-TR-001420. Publisher Copyright: © 2022 by the American Thoracic Society

PY - 2022/3/15

Y1 - 2022/3/15

N2 - Rationale: Normal values for FEV1 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. Objectives: 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. Methods: 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. Measurements and Main Results: 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 FEV1 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 FEV1, 20.005; 95% confidence interval [CI], 20.013 to 0.003; difference in C statistic for FVC, 20.008; 95% CI, 20.016 to 20.0006). Findings were similar for mortality (difference in C statistics for FEV1, 20.002; 95% CI, 20.008 to 0.003; difference in C statistics for FVC, 20.004; 95% CI, 20.009 to 0.001). Conclusions: 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.

AB - Rationale: Normal values for FEV1 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. Objectives: 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. Methods: 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. Measurements and Main Results: 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 FEV1 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 FEV1, 20.005; 95% confidence interval [CI], 20.013 to 0.003; difference in C statistic for FVC, 20.008; 95% CI, 20.016 to 20.0006). Findings were similar for mortality (difference in C statistics for FEV1, 20.002; 95% CI, 20.008 to 0.003; difference in C statistics for FVC, 20.004; 95% CI, 20.009 to 0.001). Conclusions: 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.

KW - chronic lower respiratory disease

KW - pulmonary function tests

KW - race/ethnicity–based reference equations

KW - racism

KW - spirometry

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Race/Ethnicity, Spirometry Reference Equations, and Prediction of Incident Clinical Events :The Multi-Ethnic Study of Atherosclerosis (MESA) Lung Study

Abstract

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Keywords

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UN SDGs

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