Race and PFT

It has been widely observed that Black subjects in the United States have lower forced vital capacity than white subjects, which is thought to be reflect genetic ancestry, as well as environmental and socioeconomic factors, that are difficult to disentangle.  Although current guidelines recommend using race-based pulmonary function test (PFT) interpretation strategies, there is currently a major debate whether this is still appropriate.  Advocates of using race-based PFT interpretation argue that it allows for more precise measurement, and will minimize disease misclassification.  In contrast, recent studies have shown that low lung function (especially FEV1)  in Black subjects should not be considered normal.  Furthermore, the use of race-based algorithms in medicine in general is being increasingly questioned, because they run the risk of perpetuating structural health care disparities.  Using a historical database of PFT’s performed at the University of Rochester, we are exploring how using race-based vs. race-neutral PFT reference datasets impacts the diagnostic utility of spirometry. 

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