But there is no evidence this is the case, and the lone study of the issue suggests the opposite: that Black and white individuals of the same age, sex, height, and FVC (expressed in liters) have similar long-term mortality. ![]() If the aforementioned Black man with an FEV1 of 91% predicted actually had a better prognosis than the white man with an FEV1 of 78% predicted, even though both had an identical FEV1 of 3.5 liters, the use of these race-specific equations might be appropriate, with the race-specific equations more accurately reflecting each individual’s prognosis than the use of a colorblind equation, which would suggest they had similar prognoses. The upshot is that two otherwise identical patients may be treated differently based on the color of their skin: a white patient might receive treatments not offered to a Black patient might be referred for lung transplantation earlier in their disease course and could be assigned a somewhat higher priority for receiving a lung. for organ procurement and transplantation, incorporates the percent predicted FVC in its algorithm for assigning priority for getting an organ, with individuals who are sicker being assigned a higher priority. The United Network for Organ Sharing, which administers the only network in the U.S. For individuals who already have lung disease, they are used to guide the selection of medical therapies, surgical interventions, and decisions about lung transplantation. The percentage predicted values are used in surveillance programs to detect the development of lung disease in potentially hazardous workplaces. Using race-adjusted lung function algorithms has important social and medical ramifications. Here’s an example of how these equations work: Using one commonly used prediction equation, an FEV1 of 3.5 liters would be in the normal range (91% of predicted) for a 40-year-old, 6-foot-tall Black man, but the exact same value would be considered abnormally low (78% of predicted) for a 40-year-old, 6-foot-tall white man. One of us (A.G.) uses them with his pulmonology patients, as is standard practice. At the same time, longstanding observations of racial differences led to so-called correction factors that “adjust” for race, and later, to racially specific prediction equations that basically do the same thing. That’s because lung volume gets smaller with age, is larger in taller individuals, and is smaller in women than in men.Īn understanding of these relationships led to the development of prediction lung function algorithms that convert FEV1 and FVC measurements in liters into a percent predicted adjusted for age, sex, and height. The FEV1 and FVC are difficult to interpret when given as they are measured, in liters of air. Lower lung function in Black Americans was subsequently documented in other contexts, including assessments of large, well-conducted, nationally representative samples. In the U.S., Black individuals have, on average, lower values on two key tests relative to white individuals: forced expiratory volume in one second (FEV1), which is the amount of air an individual can forcefully exhale in one second, and forced vital capacity (FVC), which is total amount of air an individual can forcefully exhale. ![]() Yet the widespread racial disparities in respiratory illness should provoke a reappraisal of the appropriateness of race-specific prediction equations that use statistics to “adjust away” the racial gap in lung function. Race-based lung function algorithms - equations used to convert raw lung volumes into age-, sex- and height- adjusted metrics that are more interpretable and useful to physicians - assume that lower lung volumes are expected, and hence “normal,” in Black people. Many studies have found that, on average, Black individuals have lower lung volumes than white people. They are also more likely to die from asthma, pneumonia, and non-Covid-19 acute respiratory distress syndrome. The Covid-19 pandemic is more likely to asphyxiate Black people than white people. ![]() But chokeholds are far from the main cause of race-based disparities in respiratory deaths in the U.S. “I can’t breathe” became a rallying cry against racism in the wake of the deaths of George Floyd and Eric Garner at the hands of the police. Exclusive analysis of biotech, pharma, and the life sciences Learn More
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