Removing race correction in lung function tests shows more severe disease in Black patients
In a new study, removing “race correction” from the interpretation of pulmonary function test results signaled more prevalent and severe lung disease in Black patients.
“The use of race correction in clinical algorithms has been the subject of significant recent debate, as it may mask and thus reinforce the effects of structural racism,” Alexander T. Moffett, MD, clinical fellow in the division of pulmonary, allergy and critical care of the Perelman School of Medicine at the University of Pennsylvania, said during a presentation at the American Thoracic Society International Conference. “Race correction, a standard practice in pulmonary function testing interpretation, results in a decrease in the predicted lower limit of normal for both FEV and FVC. The empirical consequences of applying race correction for the interpretation of pulmonary function testing are unknown.”
Researchers used ATS guidelines to interpret 14,080 pulmonary function tests both with and without race correction performed at the University of Pennsylvania Health System from 2010 to 2020. Moffett and colleagues then compared the two sets of pulmonary function test interpretations produced, with respect to the diagnosis of obstructive, restrictive and mixed pulmonary defects, as well as the severity of these defects.
With the removal of Black race correction, an additional 414 patients were diagnosed with obstruction, with an increase in the prevalence of obstructive lung disease in these patients from 22.1% to 23.9%. The removal of Black race correction also led to a diagnosis of restrictive pulmonary defects in an additional 665 patients, with an increase in the prevalence of restrictive lung disease from 8.8% to 13.5%, according to the results.
Removing race correction from pulmonary function tests resulted in an increase in the percentage of patients with any pulmonary defect from 59.5% to 81.7%.
In total, 48.6% of patients with an obstructive, restrictive or mixed pulmonary defect had an increase in disease severity after the removal of race correction.
“The removal of race correction in this cohort led to a significant increase in the diagnosis of pulmonary disease. The extent of this impact will depend upon the cohort being studied and by the way in which race correction is removed,” Moffett said. “Further work is needed to assess the role race correction may play in promoting the unequal allocation of medical resources to Black patients with pulmonary disease.”