Reconsidering the Utility of Race-Specific Lung Function Prediction Equations

Area of Science:

• Pulmonary Medicine
• Health Disparities Research
• Clinical Epidemiology

Background:

• African American individuals experience disproportionately worse outcomes in chronic obstructive pulmonary disease (COPD).
• Existing race-specific lung function prediction equations may inaccurately classify severity by considering lower lung function as normal in certain racial groups.
• This discrepancy could contribute to racial inequities in COPD diagnosis and management.

Purpose of the Study:

• To evaluate whether race-specific versus universal lung function prediction equations better model COPD outcomes.
• To determine if race-specific equations obscure the true severity of lung function decrements in African American individuals.
• To assess the impact of different equation approaches on understanding COPD-related health disparities.

Main Methods:

• A cohort study of individuals with or at risk for COPD was conducted.
• Lung function prediction equations were applied in race-specific and universal manners.
• Relationships between forced expiratory volume in 1 second (FEV1), forced vital capacity (FVC), and COPD outcomes were analyzed using multiple linear regression.
• Predictive model performance was compared using root mean squared error and Alpaydin's paired F test.

Main Results:

• Race-specific equations indicated better lung function in African American individuals compared to non-Hispanic White individuals.
• Universal equations revealed worse lung function in African American individuals.
• Universal equations demonstrated lower prediction errors for FEV1% predicted concerning COPD Assessment Test, St. George's Respiratory Questionnaire, and airway wall thickness.
• African American participants experienced greater disease adversity, but this was only associated with better FEV1 in non-Hispanic White participants.

Conclusions:

• Race-specific lung function equations may underestimate COPD severity in African American individuals.
• Universal lung function estimation appears more accurate for modeling COPD outcomes across racial groups.
• The use of race-specific equations may perpetuate or exacerbate health inequities in COPD care.