Study Projects Effects of Race-Neutral Lung Testing

The recently published study in the New England Journal of Medicine, as well as the presentation made at the American Thoracic Society’s annual meeting, brings out the impact of using race-based correction in lung function tests. This explains why Black people seem to have poorer lung function and understate the illness, said the research team headed by Raj Manrai, an assistant professor of biomedical informatics at Harvard Medical School (HMS).
Manrai also argues that race-based formulas presuppose a genetic distinction in lung function which can lead to underestimating the disease severity in many people. This study will seek to provide some quantification of the effects of eliminating race from these evaluations. The results of the analysis indicate that the exclusion of race from lung function estimates would affect the diagnosis of respiratory diseases and eligibility for disability compensation and veteran’s benefits as well as employment requiring specific levels of lung function.
Manrai and first author James Diao examined the effect of decoupling race from GFR estimation previously. This new research is also similar to their earlier work to better prepare healthcare providers and systems to provide the best care even if there are potential changes in disease status because of race-neutral lung function equations. It also intends to help policymakers strategize for shifts in disease prevalence and the way people qualify for work and disability benefits.

Diao, a fourth-year HMS medical student, highlights the clinical, economic, and work implications of racializing pulmonary function testing. The results of the study will help to determine what constitutes ‘normal variation’ and ‘impairment or disease’, as well as inform the legacy of race-based medical testing.
Although race cannot be a determining factor in biological context, it has been used in some medical tests and therapies to represent disease disparities across patient communities. The recent changes in medical practice started in 2020 with the elimination of race from estimating the function of kidneys: The same questions can be asked about lung function tests. Spirometry, which has been used since the mid-nineteenth century to measure lung capacity, traditionally contour-curves race-adjusted reference ranges and therefore expected lower results from Blacks.
In 2022, GLI abandoned race-based equations and adopted race-neutral equations which was endorsed by the American Thoracic Society and the European Respiratory Society. Despite being incomplete, race-neutral estimates attempt to go beyond the long-held view that group-level differences in lung function are biological.
Manrai argues that these organizations look for the kind of data presented in Analysis 2 which provides key information, conclusions, and recommendations for unified decisions. The researchers sourced information concerning 370,000 participants in several databases like the NHANES and the UK Biobank which provided spirometry scores.
They estimated lung function with both standard race-inclusive formulae and more recent race-neutral equations and assessed the effects of race correction on disease stage, lung transplant priority, disability benefits and other outcomes. The study was able to show that race did not significantly influence the overall accuracy of the prediction of symptoms, but the equations did identify disease severity differently between black and white individuals. Race-neutral formula identified sicker Black patients and less sick white and Hispanic patients.

This means that race-based adjustments have long masked lung disease severity for many Black patients. The research team used these insights to extrapolate the impact of adopting race-neutral formulas across the United States population.

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