Pulmonary Testing Based on Race, Ethnicity Found Flawed
The use of race and ethnicity in the interpretation of pulmonary function tests (PTFs) has no significant value, and data supporting this use are limited and unreliable, according to a statement issued by several thoracic societies.
“There is growing concern that the use of race/ethnicity in medicine, often arbitrarily inferred based on appearance, as biological variables may perpetuate inequalities in outcomes,” wrote Darcy D. Marciniuk, MD, of the University of Saskatchewan, Canada, and colleagues. In respiratory medicine, “the use of race- and ethnic-specific reference equations for the interpretation of Pulmonary Function Tests warrants reconsideration,” they said.
In a statement published jointly by the American College of Chest Physicians, the American Thoracic Society, the American Association for Respiratory Care, and the Canadian Thoracic Society, an expert panel presented its evidence review regarding three key questions: use of race- and ethnicity-specific reference equations for interpreting pulmonary function tests; the potential clinical implications of the use or nonuse of race and ethnicity in interpreting PFT results; and research gaps.
Historically, PFT values have been compared with a healthy reference population; although the characteristics of this group have evolved, healthy reference populations do not account for many factors that affect lung health, which has resulted in individuals from marginalized communities being disproportionately mislabeled as “healthy,” the panelists said.
The panel conducted a literature review and identified seven studies to address the question: “What is the current evidence supporting the use of race/ethnicity-specific reference equations for the interpretation of PFTs?” Based on the studies, they noted that significant differences in forced expiratory volume in 1 second (FEV1) and forced vital capacity (FVC) but not in the FEV1-FVC ratio have been identified between different racial and ethnic groups. Results suggested that the proportional differences in FEV1 and FVC between ethnicities stem from different lung sizes and not from airflow obstruction.
Regarding the second question, “What are the potential clinical implications of the use or non-use of race/ethnicity in interpreting PFT results?” the authors reviewed 22 studies, including eight with new reference equations within subpopulations. The data suggested that ethnic reference values improved accuracy over the Third National Health and Nutrition Exam Survey values.
The authors also concluded that “Changing from one reference equation to another can change the quantification of relative lung function of individuals in comparison to reference values.”
The authors identified several research priorities to address the third question: “What research gaps and questions must be addressed and answered to better understand the effect of race/ethnicity on PFT interpretation and potential clinical and occupational health implications?”
Their recommendations included using clear and standardized definitions of terms such as race and ethnicity in research; establishing guidance for how, if at all, race and ethnicity should be factored into lung function studies; and incorporating precise measures in interpretation of PFTs.
Some notable research gaps involved the need to use validated instruments to measure the effects of social determinants of health on lung health and to understand all factors that contribute to lung health and safety, the authors said.
“There is an urgent need for more and better research that will inform our field about these many uncertainties and serve as a foundation for future recommendations in this area,” the authors wrote in their discussion. “We need to be ready to accept and implement new guidance considering this evidence and acknowledge that the solutions available today may not be ideal and require careful consideration of the individual context,” they said.
The study received no outside funding. The panelists had no relevant financial conflicts to disclose.
Chest. 2023 March 18, 2023. Full text
For more news, follow Medscape on Facebook, Twitter, Instagram, and YouTube
Source: Read Full Article
