A multi-institutional team of researchers and physicians has proposed updates to the American Medical Association (AMA) Guides to the Evaluation of Permanent Impairment. The recommendation advocates to end race-based assessments of lung function.
The paper, “Reform and Remedy for Imprecision and Inequity — Ending the Race-Based Evaluation of Occupational Pulmonary Impairment,” was recently published in The New England Journal of Medicine. It outlines the history of race as an element in pulmonary testing to quantify lung function impairment or disability and determine if a person is eligible for worker’s compensation.
The authors suggest steps for reevaluating how occupational impairment is determined to help make the process more equitable, said a Mass General Brigham press release.
“Race has long been inappropriately used as a proxy for biological traits in medical care and research, including in lung function testing reference equations used to evaluate how much someone’s lung function is impaired,” said lead author Rohan Khazanchi, MD, MPH. “National guidelines from the American Thoracic Society and European Respiratory Society now advocate against the use of race in lung function equations, but there are significant barriers to de-implementation.”
Dr. Khazanchi is a resident physician in the Harvard Internal Medicine & Pediatrics combined residency program at Brigham and Women’s Hospital, Boston Children’s Hospital and Boston Medical Center.
The implications of the team’s proposal go beyond the clinical care setting to areas of evaluating impairment and disability, said Nirav Bhakta, MD, PhD, professor of medicine in the division of pulmonary and critical care medicine at the University of California, San Francisco.
The team worked closely with the AMA on its modified recommendations to the AMA Guides, which are utilized at the federal and state levels as well as by international government agencies as the “gold standard” for evaluating worker’s compensation claims.
The current edition of the AMA Guides still endorses the use of race-based reference equations for spirometry. The new proposal specifies the consequences of adjusting spirometry results due to a person’s race. Previous studies stressed biological justifications for racial differences and ignored known social or environmental factors that predict lung-related health outcomes, the authors said.
While the AMA has acknowledged the recommendation and said it will be reflected in the next version of the AMA Guides, the authors noted that it doesn’t solve the complex issue of ensuring equitable pulmonary evaluations now and going forward.
“The medical field should critically reevaluate the whole ecosystem surrounding pulmonary impairment evaluations — including and beyond the choice of reference equations,” they wrote.
Additionally, the research team underscored the need to remedy damages caused by race-based equations, especially for patients whose degree of lung function impairment may have been underestimated, therefore impacting their disability ratings or worker’s compensation payments.
