Browse ATS 2021 Abstracts

HomeProgram ▶ Browse ATS 2021 Abstracts

ATS 2021 will feature presentations of original research from accepted abstracts. Mini Symposia and Thematic Poster Sessions are abstract based sessions.

Please use the form below to browse scientific abstracts and case reports accepted for ATS 2021. Abstracts presented at the ATS 2021 will be published in the Online Abstract Issue of the American Journal of Respiratory and Critical Care Medicine, Volume 203, May 3, 2021.

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The Impact of Race Correction on the Interpretation of Pulmonary Function Testing Among Black Patients

Session Title
A1030 - The Impact of Race Correction on the Interpretation of Pulmonary Function Testing Among Black Patients
Author Block: A. T. Moffett, N. D. Eneanya, S. D. Halpern, G. E. Weissman; Palliative and Advanced Illness Research (PAIR) Center, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, United States.
Rationale: 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, including known disparities in care processes and outcomes for Black patients with pulmonary diseases. Race correction, a standard practice in pulmonary function testing (PFT) interpretation, results in a decrease in the predicted lower limit of normal for both FEV1 and FVC. The empirical consequences of race correction for the interpretation of pulmonary function testing are unknown. Methods: We used American Thoracic Society guidelines to interpret pulmonary function tests performed at the University of Pennsylvania Health System between 2010 and 2020 involving patients who self-identified as Black or African-American. These guidelines were applied using the reference values for spirometry developed by the Global Lung Function Initiative, both with and without race correction. We compared the two sets of interpretations thus produced with respect to the diagnosis of obstructive, restrictive, and mixed pulmonary defects, along with the gradation of severity of these defects. We also identified a composite diagnosis of any pulmonary defect, defined as an FEV1, FVC, FEV1/FVC, or TLC below the lower limit of normal. Results: We interpreted 14,080 pulmonary function tests both with and without race correction. The removal of Black race correction led to a diagnosis of obstruction for an additional 414 patients and an increase in the prevalence of obstructive lung disease in this cohort from 22.1% to 23.9%, a difference of 1.7% (95% confidence interval [CI] 1.5%-1.9%). Removal also led to the diagnosis of restriction for an additional 665 patients, an increase in the prevalence of restrictive lung disease from 8.8% to 13.5%, a difference of 4.7% (95% CI 4.4%-5.1%). Among patients with an obstructive, restrictive, or mixed defect, the percentage for whom removal led to an increase in the severity of disease was 48.6% (95% CI 47.2%-50.0%, Figure). Removal led to an increase in the percentage of patients with any pulmonary defect from 59.5% to 81.7%, a difference of 20.8% (95% CI 20.6%-21.9%). Conclusions: The removal of Black race correction in PFTs, a standard clinical practice without a biological basis, led to a significant increase in the diagnosed prevalence and severity of pulmonary disease among Black patients. Further work is needed to assess the role race correction may thus play in promoting the unequal allocation of medical resources to Black patients with pulmonary disease.