Is it time to end race and ethnicity adjustment for pediatric pulmonary function tests?

Area of Science:

• Pediatric Pulmonology
• Medical Biostatistics
• Health Equity

Background:

• The use of race in spirometry reference equations for children is debated, impacting diagnosis of respiratory conditions like asthma.
• Racial bias in lung function interpretation is critical given higher respiratory illness burdens in minority groups.
• Accurate pediatric lung function estimates are vital for diagnosing conditions such as cystic fibrosis and interstitial lung disease.

Purpose of the Study:

• To recommend against the continued use of race-specific spirometry reference equations in children.
• To highlight the limitations of existing race-based equations and propose alternative approaches.
• To emphasize the need to identify underlying factors contributing to racial disparities in lung function.

Main Methods:

• Review of existing literature on spirometry reference equations and racial bias in pediatric populations.
• Analysis of the scientific and physiological basis for race-specific lung function differences.
• Examination of environmental and socioeconomic factors influencing lung development.

Main Results:

• Existing race-specific spirometry equations were developed using non-diverse, small, and potentially unhealthy pediatric populations.
• There is no scientific or genetic basis for innate racial differences in lung function.
• Environmental factors (e.g., allergens, pollution, preterm birth) disproportionately affect minority groups and impact lung development.

Conclusions:

• Continued use of race-specific spirometry equations in children is not scientifically justified and may perpetuate health inequities.
• Race-neutral equations offer a potential interim solution but require diverse reference populations.
• Future research must investigate the true drivers of lung function disparities, focusing on environmental and socioeconomic determinants.