Measuring Lung Function More Accurately and More Equitably

New analysis estimates the effects of race-neutral lung function testing on patients, hospitals, and beyond

digital illustration of human body, with respiratory system highlighted
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At a glance:

  • Race-based assessments of lung function have historically assumed different levels of “normal” for different patient groups.
  • New analysis shows that removing from lung function estimates would increase the number of Black patients diagnosed with serious disease.
  • Greater estimated disease severity would change a patient’s diagnosis, disability compensation, eligibility for certain jobs.
  • The study findings should help clinicians, hospitals, policymakers plan for shifts in disease burden, allocate resources accordingly.

Removing race from equations that estimate lung function will shift the categorization of disease severity across patient populations, moving more Black individuals into an advanced disease category, according to new research led by scientists at Harvard Medical School. At the same time, more white and Hispanic people would be reclassified as having less advanced illness.

The findings, the research team said, suggest that adjusting lung function tests to include race — as has been the case historically — likely normalized worse lung function and downplayed disease severity among Black people.

The work, published May 19 in the New England Journal of Medicine, was presented simultaneously at a special session of the annual meeting of the American Thoracic Society.

“The race-based formula to estimate lung function assumes that different race groups have different normal lung function, and it’s known that this can obscure disease severity in many individuals,” said study senior author Raj Manrai, assistant professor of biomedical informatics in the Blavatnik Institute at HMS. “Yet the myriad implications of race adjustment and the effects of removing race have not been comprehensively quantified — our study is an attempt do so.”

The analysis shows that removing race from current lung function estimates would change who is diagnosed with respiratory illness and, in turn, who qualifies for disability compensation and veterans’ benefits and who’s eligible for jobs that require certain levels of lung function.

Manrai and study first author James Diao previously led research to assess the implications of removing race from estimates of kidney function.