Race-neutral lung function reference equations in Africa: Does it matter?

The move toward race-neutral spirometry reference equations represent an important step away from embedding socially constructed racial categories within clinical interpretation. However, the implications of this shift in African settings need consideration. This paper summarizes the evolution of lung function interpretation from a race-specific to a race-neutral framework, the rationale for this change, and the gathering evidence for the implications of this change with a focus on Africa. The multifactorial determinants of population difference are discussed, and the complexity of incorporating population difference in healthy reference standards is detailed. The urgent need to move away from a statistical threshold to define health and disease is highlighted, and a practical approach to current interpretation is put forward. Finally, a pathway to a strengthened lung health assessment in Africa is proposed.