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

101 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

UN SDGs

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

SDG 3 Good Health and Well-being

Keywords

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

Publisher link

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",

issn = "1073-449X",

publisher = "American Thoracic Society",

number = "6",

}

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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UR - https://www.scopus.com/pages/publications/85126830678#tab=citedBy

U2 - 10.1164/RCCM.202107-1612OC

DO - 10.1164/RCCM.202107-1612OC

M3 - Article

C2 - 34913853

AN - SCOPUS:85126830678

SN - 1073-449X

VL - 205

SP - 700

EP - 710

JO - American journal of respiratory and critical care medicine

JF - American journal of respiratory and critical care medicine

IS - 6

ER -

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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