{"doi":"10.1016/j.chest.2023.06.011","title":"Diagnostic Impact of a Race-Composite Pulmonary Function Test Results Interpretation Strategy","abstract":"It has been observed historically that lung function varies by race and ethnicity, even after accounting for differences in height, sex, and age. Until recently, guidelines have recommended using race-specific reference values to interpret pulmonary function test (PFT) results.1Pellegrino R. Viegi G. Brusasco V. et al.Interpretative strategies for lung function tests.Eur Respir J. 2005; 26: 948-968Crossref PubMed Scopus (4405) Google Scholar Many potential confounding factors contribute to population differences in lung function that transcend race, including socioeconomic status and environmental exposures.2Hegewald M.J. Crapo R.O. Socioeconomic status and lung function.Chest. 2007; 132: 1608-1614Abstract Full Text Full Text PDF PubMed Scopus (157) Google Scholar,3Lum S. Bountziouka V. Sonnappa S. et al.Lung function in children in relation to ethnicity, physique and socioeconomic factors.Eur Respir J. 2015; 46: 1662-1671Crossref PubMed Scopus (30) Google Scholar Furthermore, because race is a social construct, the use of race-based interpretation strategies runs the risk of perpetuating structural health care disparities.4Braun L. Wolfgang M. Dickersin K. Defining race/ethnicity and explaining difference in research studies on lung function.Eur Respir J. 2013; 41: 1362-1370Crossref PubMed Scopus (89) Google Scholar,5Vyas D.A. Eisenstein L.G. Jones D.S. Hidden in plain sight—reconsidering the use of race correction in clinical algorithms.N Engl J Med. 2020; 383: 874-882Crossref PubMed Scopus (816) Google Scholar Although the limitations of using race-based reference equations increasingly are recognized, potential risks of not including race in interpretative strategies for PFT results also exist,6Townsend M.C. Cowl C.T. US occupational historical perspective on race and lung function.Am J Respir Crit Care Med. 2022; 206: 789-790Crossref PubMed Scopus (7) Google Scholar and the best alternative approach currently is not clear.7Bhakta N.R. Kaminsky D.A. Bime C. et al.Addressing race in pulmonary function testing by aligning intent and evidence with practice and perception.Chest. 2022; 161: 288-297Abstract Full Text Full Text PDF PubMed Google Scholar In an effort to balance these risks and benefits and to avoid perpetuating systemic racism, the American Thoracic Society recently published guidelines recommending a transition to race-composite reference equation use in interpretation of PFT findings. The Global Lung Initiative (GLI) established reference PFT equations from healthy participants of multiple races and ethnicities who did not use tobacco.8Quanjer P.H. Stanojevic S. Cole T.J. et al.Multi-ethnic reference values for spirometry for the 3-95-yr age range: the global lung function 2012 equations.Eur Respir J. 2012; 40: 1324-1343Crossref PubMed Scopus (3735) Google Scholar One approach to performing race-neutral PFT results interpretation is to use a composite of reference values from all the included racial and ethnic groups, also known as GLI Other (GLI-O). The usefulness of GLI-O recently was examined in two articles. First, McCormack et al9McCormack M.C. Balasubramanian A. Matsui E.C. et al.Race, lung function, and long-term mortality in the National Health and Nutrition Examination Survey III.Am J Respir Crit Care Med. 2022; 205: 723-724Crossref PubMed Google Scholar reanalyzed data from the Third National Health and Nutrition Examination Survey (NHANES III) survey and found that the use of FEV1 z scores derived from GLI-O predicted mortality similarly to race-based approaches. Second, Baugh et al10Baugh A.D. Shiboski S. Hansel N.N. et al.Reconsidering the utility of race-specific lung function prediction equations.Am J Respir Crit Care Med. 2022; 205: 819-829Crossref PubMed Scopus (44) Google Scholar reanalyzed data from the Subpopulations and Intermediate Outcome Measures in COPD Study (SPIROMICS) and concluded that FEV1 % predicted calculated using GLI-O more consistently identifies Black patients at high risk, i","journal":"CHEST Journal","year":2023,"id":380189,"datarank":0.0,"base_score":0.0,"endowment":0.0,"self_citation_contribution":0.0,"citation_network_contribution":0.0,"self_endowment_contribution":0.0,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":6,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.9687,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2023-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":1011687,"name":"Patrick Donohue","orcid":"0000-0001-6387-4555","position":1,"is_corresponding":false},{"id":432138,"name":"Rohith Palli","orcid":"0000-0001-7252-4266","position":2,"is_corresponding":false},{"id":628709,"name":"Sandhya Khurana","orcid":"0000-0002-3167-1152","position":3,"is_corresponding":false},{"id":242964,"name":"Xueya Cai","orcid":"0000-0001-7922-2703","position":4,"is_corresponding":false},{"id":251405,"name":"Steve N. Georas","orcid":"0000-0002-2361-422X","position":5,"is_corresponding":false},{"id":1011689,"name":"Margaret Connolly","orcid":"0000-0001-7435-6921","position":0,"is_corresponding":true}],"reference_count":16,"raw_metadata":null,"created_at":"2026-07-19T01:17:00.789848Z","pmid":"37421975","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}