Editorial: “Race Correction” in Pulmonary-Function Testing

Editorial: “Race Correction” in Pulmonary-Function Testing

New England Journal of Medicine
DOI: 10.1056/NEJMe1005902

Paul D. Scanlon, M.D.
Division of Pulmonary and Critical Care Medicine
Mayo Clinic, Rochester, Minnesota

Mark D. Shriver, Ph.D.
Department of Anthropology
Pennsylvania State University, University Park (M.D.S.)

Tests of pulmonary function and radiographic imaging of the chest are the two key methods used in diagnostic evaluation of patients with pulmonary disease. Unlike blood pressure, acceptable normal values vary from person to person and from one demographic group to another. The first studies, in 1846, of spirometric assessment of forced vital capacity (FVC), the most basic pulmonary-function test, showed that normal values for vital capacity vary as a function of height and age. A few years later, it was shown that vital capacity was 6 to 12% lower in healthy black soldiers than in white or Native American soldiers. It has since become standard practice to calculate, for any individual patient, normal reference values for pulmonary-function tests on the basis of population-specific reference-value equations. In North America and Europe, where majority populations have primarily European ancestry, it is common practice to adjust reference values for persons of African or African-American ancestry, Hispanic ethnicity, or Asian ancestry—an adjustment termed “race correction” or “ethnic adjustment.”…

…There are practical problems with “race correction.” Self-identified race is the accepted standard for defining race, and no allowance is made for admixture (i.e., mixed parentage). The Asian-American adjustment factor is based on two studies with small numbers of participants representing a limited range of ages, ethnic groups, and socioeconomic status. A larger, recently published study showed that for Asian Americans, a correction factor of 0.88 is more accurate than 0.94.5 And little consideration has been given to the genetic diversity within Africa and within Asia.

Moreover, there is debate regarding the appropriateness of “race correction,” and a more general debate about the concepts of “race,” “ethnicity,” and “genetic ancestry” in medical research and treatment. Does race truly exist? If so, should it be taken into account, not only in pulmonary-function testing, but also in the broader practice of medicine and biomedical research?…

Read the entire editorial here.

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