Racial equations are often included in diagnostic screenings, and they can either help or hinder. The new study, “Race-Specific and Race-Neutral Equations for Lung Function and Asthma Diagnosis in Black Children,” revealed that the use of race-neutral equations significantly improved the detection of reduced lung function and asthma in Black children compared to race-specific equations. The study was recently published in JAMA Network Open.
Researchers analyzed data from 1,533 children across three cohorts, comparing race-specific and race-neutral equations for lung function based on forced expiratory volume in one second (FEV1) and forced vital capacity (FVC).
Using race-neutral questions, Black children showed a significantly lower percent predicted FEV1 and FVC, leading to a higher detection rate of reduced lung function and an increased likelihood they should receive additional testing and treatment. Race-specific equations failed to detect reduced lung function in 39% of Black children.
The study included data from the Childhood Asthma Management Program (CAMP), the Cincinnati Childhood Allergy and Air Pollution Study (CCAAPS) and the Mechanisms of Progression from Atopic Dermatitis to Asthma (MPAACH) cohorts.
Children in the CAMP cohort were five to 12 years old with mild-to-moderate asthma, while the CCAAPS and MPAACH cohorts included infants whose parents have atopic dermatitis (a skin condition often linked to asthma) and children from birth to two years of age with atopic dermatitis. Researchers noted that 38-44% of Black children in the CCAPS and MPAACH cohorts who did not initially qualify for additional diagnostic testing became eligible when using the race-neutral equation. There was no distinct impact on lung function tests when the race-neutral equation was used on White children. Researchers suggested this demonstrates that the race-specific equation overestimates lung function in Black children, leading to underdiagnosis of asthma in this cohort.
Researchers said their findings support the universal use of race-neutral equations to decrease underdiagnosis and delayed treatment, improve asthma detection and promote health equity. Additionally, the use of race-neutral equations aligns with the American Thoracic Society’s 2023 recommendations to adopt a race-neutral approach in pulmonary function testing.
