Is it time to end race and ethnicity adjustment for pediatric pulmonary function tests?

Our plain-English summary of Is it time to end race and ethnicity adjustment for pediatric pulmonary function tests?, by A.L. Non, K. Akong, D.J. Conrad (Pediatric Pulmonology, 2024).

The study

• Authors: A.L. Non, K. Akong, D.J. Conrad
• Journal: Pediatric Pulmonology
• Published: 2024;59(12):3806-3811
• Type of article: Review
• Cited by: 3 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

The continued inclusion of race in spirometry reference equations is a topic of intense debate for adult lung function, but less discussion has focused on implications for children. Obtaining accurate estimates of children's lung function is an important component of the diagnosis of childhood respiratory illnesses, including asthma, cystic fibrosis, and interstitial lung disease. Given the higher burden among racial/ethnic minorities for many respiratory illnesses, it is critical to avoid racial bias in interpreting lung function. We recommend against the continued use of race-specific reference equations for a number of reasons. The original reference populations used to develop the equations were comprised of children with restricted racial diversity, relatively small sample sizes, and likely included some unhealthy children. Moreover, there is no scientific justification for innate racial differences in lung function, as there is no clear physiological or genetic explanation for the disparities. Alternatively, many environmental factors harm lung development, including allergens from pests, asbestos, lead, prenatal smoking, and air pollution, as well as preterm birth and childhood respiratory illnesses, which are all more common among minority racial groups. Race-neutral equations may provide a temporary solution, but still rely on the racial diversity of the reference populations used to build them. Ultimately researchers must uncover the underlying factors truly driving racial differences in lung function.

© 2023 The Authors. Pediatric Pulmonology published by Wiley Periodicals LLC.

In plain English

Although the journal labeled it an 'Original Article,' this article reported no new study: it discussed published work, and the authors stated that no datasets were generated or analyzed. It asked whether equations used to interpret children's spirometry (breathing tests) should keep adjusting for race and ethnicity, and the authors recommended against race-specific equations. They argued that the reference populations behind these equations had limited racial diversity. For example, in the Global Lung Function Initiative data for children aged 5–10, 96% were White, 2.6% African American and 1.7% South East Asian. They also argued that not all children in these reference groups were necessarily healthy, and that there is no clear genetic or physiological explanation for racial differences in lung function. Asbestos was mentioned twice, in the abstract and the main text, each time in a list of environmental hazards. In the main text, citing other work, the authors said racial/ethnic minority children are more likely to be exposed to them. The lists also included pest allergens, lead, prenatal smoking and air pollution. The article presented no asbestos data. The authors concluded that continued use of race-specific equations is unwarranted.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Published under the heading 'Original Article', but a discussion of published work. No new data were collected or analyzed.
• Who was studied: No study population. The authors discussed the reference populations used to build pediatric spirometry equations (NHANES III, Wang et al., Global Lung Function Initiative).
• Exposure: Not an asbestos study. Asbestos was mentioned twice, in the abstract and in the main text, each time in a list of environmental hazards. In the main text, citing another source, the authors said racial/ethnic minority children are more likely to be exposed to these hazards.
• Main results:
  • The authors pointed out that, in the Global Lung Function Initiative data used to build equations for children aged 5–10, 96% were White, 2.6% African American and 1.7% South East Asian.
  • The authors argued that not all individuals in the reference groups behind these equations were necessarily healthy.
  • The authors argued that there is no clear physiological explanation for lung function differences between racial groups.
  • The authors reported that at least four other studies found the race-neutral GLI-other equation predicted disease or mortality as well as or better than race-specific equations.
• The authors' conclusion: The authors concluded that, because racial differences in lung function are not yet fully explained by any known genetic or environmental factors, continued use of race-specific equations is unwarranted.

Topics

Medical terms in this study, explained in our Lexicon: Pulmonary Function Test (PFT), Spirometry, Fibrosis, Interstitial Lung Disease.

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