Comparison of Race-Neutral versus Race-Specific Spirometry Equations for Evaluation of Child Asthma

<b>Rationale:</b> Race-based estimates of pulmonary function in children could influence the evaluation of asthma in children from racial and ethnic minoritized backgrounds. <b>Objectives:</b> To determine if race-neutral (Global Lung Function Initiative [GLI]-Global) versus race-specific (GLI-Race-Specific) reference equations differentially impact spirometry evaluation of childhood asthma. <b>Methods:</b> The analysis included 8,719 children aged 5 to <12 years from 27 cohorts across the United States grouped by parent-reported race and ethnicity. We analyzed how the equations affected FEV<sub>1</sub>, FVC, and FEV<sub>1</sub>/FVC <i>z</i>-scores. We used multivariable logistic models to evaluate associations between <i>z</i>-scores calculated with different equations and asthma diagnosis, emergency department visits, and hospitalization. <b>Measurements and Main Results:</b> For Black children, the GLI-Global versus GLI-Race-Specific equations estimated significantly lower <i>z</i>-scores for FEV<sub>1</sub> and FVC but similar values for FEV<sub>1</sub>/FVC, thus increasing the proportion of children classified with low FEV<sub>1</sub> by 14%. Although both equations yielded strong inverse relationships between FEV<sub>1</sub> and FEV<sub>1</sub>/FVC <i>z</i>-scores and asthma outcomes, these relationships varied across racial and ethnic groups (<i>P</i> < 0.05). For any given FEV<sub>1</sub> or FEV<sub>1</sub>/FVC <i>z</i>-score, asthma diagnosis and emergency department visits were higher among Black and Hispanic than among White children (<i>P</i> < 0.05). For FEV<sub>1</sub>, GLI-Global equations estimated asthma outcomes that were more uniform across racial and ethnic groups. <b>Conclusions:</b> Parent-reported race and ethnicity influenced relationships between lung function and asthma outcomes. Our data show no advantage to race-specific equations for evaluating childhood asthma, and the potential for race-specific equations to obscure lung impairment in disadvantaged children strongly supports using race-neutral equations.

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Publication Details

Journal
American Journal of Respiratory and Critical Care Medicine
Published
2024-12-06
DOI
https://doi.org/10.1164/rccm.202407-1288oc
Citations
3
Primary Topic
Asthma and respiratory diseases
Type
article
Field-Weighted Citation Impact
0.98
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article

Comparison of Race-Neutral versus Race-Specific Spirometry Equations for Evaluation of Child Asthma

Annemarie Stroustrup, Nathan Schoettler, Judy L. Aschner, Christian Rosas‐Salazar et al.
3 citations
American Journal of Respiratory and Critical Care Medicine
Asthma and respiratory diseases
0.98
article

Comparison of Race-Neutral versus Race-Specific Spirometry Equations for Evaluation of Child Asthma

Annemarie Stroustrup, Nathan Schoettler, Judy L. Aschner, Christian Rosas‐Salazar, Diane R. Gold, Katherine Rivera‐Spoljaric, James E. Gern, Daniel J. Jackson, Meredith Palmore, Dennis R. Ownby, Tina V. Hartert, Miranda R. Jones, Amy L. Non, Edward M. Zoratti, Carrie V. Breton, Sima K. Ramratnam, Christine L.M. Joseph, Alexandra R. Sitarik, Douglas Conrad, Meyer Kattan, Rachel L. Miller, Leonard B. Bacharier, Carlos A. Camargo, Margaret Rita Karagas, Cindy T. McEvoy, Flory L. Nkoy, Eric Schauberger, Shohreh F. Farzan, Anne Marie Singh, Frank D. Gilliland, Emily Oken, Kelan G. Tantisira, Augusto A. Litonjua, Kecia N. Carroll, Heike Luttmann‐Gibson, Xiuhong Li, Patrick Ryan, Robert F. Lemanske
article en
3 citations

Abstract

<b>Rationale:</b> Race-based estimates of pulmonary function in children could influence the evaluation of asthma in children from racial and ethnic minoritized backgrounds. <b>Objectives:</b> To determine if race-neutral (Global Lung Function Initiative [GLI]-Global) versus race-specific (GLI-Race-Specific) reference equations differentially impact spirometry evaluation of childhood asthma. <b>Methods:</b> The analysis included 8,719 children aged 5 to <12 years from 27 cohorts across the United States grouped by parent-reported race and ethnicity. We analyzed how the equations affected FEV<sub>1</sub>, FVC, and FEV<sub>1</sub>/FVC <i>z</i>-scores. We used multivariable logistic models to evaluate associations between <i>z</i>-scores calculated with different equations and asthma diagnosis, emergency department visits, and hospitalization. <b>Measurements and Main Results:</b> For Black children, the GLI-Global versus GLI-Race-Specific equations estimated significantly lower <i>z</i>-scores for FEV<sub>1</sub> and FVC but similar values for FEV<sub>1</sub>/FVC, thus increasing the proportion of children classified with low FEV<sub>1</sub> by 14%. Although both equations yielded strong inverse relationships between FEV<sub>1</sub> and FEV<sub>1</sub>/FVC <i>z</i>-scores and asthma outcomes, these relationships varied across racial and ethnic groups (<i>P</i> < 0.05). For any given FEV<sub>1</sub> or FEV<sub>1</sub>/FVC <i>z</i>-score, asthma diagnosis and emergency department visits were higher among Black and Hispanic than among White children (<i>P</i> < 0.05). For FEV<sub>1</sub>, GLI-Global equations estimated asthma outcomes that were more uniform across racial and ethnic groups. <b>Conclusions:</b> Parent-reported race and ethnicity influenced relationships between lung function and asthma outcomes. Our data show no advantage to race-specific equations for evaluating childhood asthma, and the potential for race-specific equations to obscure lung impairment in disadvantaged children strongly supports using race-neutral equations.

American Journal of Respiratory and Critical Care MedicineVol. 211(3)
Dartmouth College (US), University of Southern California (US), Brigham and Women's Hospital (US), Cincinnati Children's Hospital Medical Center (US), Albert Einstein College of Medicine (US), Massachusetts Department of Public Health (US), University of Wisconsin–Madison (US), Harvard University (US), Hofstra University (US), Johns Hopkins University (US), Henry Ford Health System (US), Oregon Health & Science University (US), Vanderbilt University (US), Washington University in St. Louis (US), University of Utah (US), Augusta University (US), Columbia University Irving Medical Center (US), Henry Ford Hospital (US), University of California System (US), University of Rochester Medical Center (US), University of California San Diego (US), University of Chicago (US), Rady Children's Hospital-San Diego (US), Massachusetts General Hospital (US), Monroe Carell Jr. Children's Hospital (US), Michigan United (US), Harvard Pilgrim Health Care (US), Cohen Children's Medical Center (US), Golisano Children's Hospital (US), Pediatrics and Genetics (US), Center for Discovery (US), University of Cincinnati (US), Columbia University (US), Michigan State University (US), Vanderbilt University Medical Center (US), University of Cincinnati Medical Center (US), Icahn School of Medicine at Mount Sinai (US)
Gender equality
Openalex Percentile: Top 22%
Asthma and respiratory diseases
0.98
DOIOpen Access PDFOpenAlex
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