Impacts of Altering Spirometric Prediction Equations in Occupational Health

Area of Science:

• Occupational Medicine
• Pulmonary Physiology
• Health Disparities

Background:

• Spirometry is crucial for diagnosing occupational lung diseases.
• Current spirometry prediction equations often incorporate race-based adjustments.
• The GLI-Global initiative aims to provide unified, "race-neutral" spirometry prediction equations.

Purpose of the Study:

• To assess the implications of implementing "race-neutral" GLI-Global spirometry prediction equations in occupational medicine.
• To evaluate how these changes affect lung function predictions across different racial groups of male workers.

Main Methods:

• Applied GLI-Global spirometry prediction equations to hypothetical male subjects.
• Examined four different reference/prediction equations.
• Analyzed predictions across four racial groups (White, Northeast Asian, Southeast Asian, Black).
• Assessed outcomes at 80%, 100%, and 120% of race-specific predicted forced vital capacity (FVC).

Main Results:

• The impact of switching to GLI-Global predictions varied significantly by racial group, with effects ordered: White > Northeast Asian > Southeast Asian > Black.
• GLI-Global predicted values generally fell between those previously predicted for Black and White individuals.
• For individuals with lower lung function (80% predicted FVC), Black and Southeast Asian groups showed decreasing %predicted values and Z-scores, alongside increasing FVCs below the lower limit of normal (LLN).
• Conversely, White and Northeast Asian groups exhibited increasing %predicted values and Z-scores, with decreasing FVCs below LLN.

Conclusions:

• Occupational medicine clinicians and policymakers need to carefully consider the diverse implications of adopting new, "race-neutral" spirometry prediction equations.
• The shift to GLI-Global equations may alter the interpretation of lung function, potentially affecting diagnoses and management of occupational lung diseases.
• Further research is warranted to understand the full impact on worker health surveillance and regulatory standards.