Race-Neutral Equations and Pulmonary Function Test Interpretation in Two Pediatric Cohorts

Area of Science:

• Pediatric pulmonology
• Respiratory medicine
• Health equity

Background:

• Spirometry interpretation traditionally used race-specific equations.
• Recent shifts towards race-neutral equations aim for greater equity.
• The impact of these new equations on pediatric lung function predictions requires investigation.

Purpose of the Study:

• To evaluate changes in predicted lung function measurements in children using new Global Lung Initiative (GLI) race-neutral equations.
• To compare spirometry results interpreted with race-neutral versus race-specific GLI equations.
• To assess the association of race with respiratory impairment prevalence and severity under new guidelines.

Main Methods:

• Analysis of data from two prospective multicenter cohorts of healthy children and those with a history of severe bronchiolitis.
• Spirometry data from 677 children at their 6-year physical exam were analyzed using both new GLI Global and 2012 GLI equations.
• Multivariable logistic regression, adjusted for age, height, and sex, examined race's association with new or increased respiratory impairment (FEV1 z-score ≤ -1.645) per 2022 American Thoracic Society guidelines.

Main Results:

• Race-neutral equations increased predicted FEV1 and FVC in White children but decreased them in Black children.
• Obstruction prevalence rose by 21% in White children; possible restriction increased by 222% in Black children.
• Black race was significantly associated with higher prevalence (aOR 7.59) and severity (aOR 35.40) of respiratory impairments compared to White race.

Conclusions:

• The adoption of race-neutral spirometry reference equations resulted in increased prevalence and severity of respiratory impairments among Black children.
• These findings underscore the critical need to address racial disparities in respiratory health assessments.
• The study supports the removal of race from spirometry interpretation due to lack of biological justification and observed inequities.