Adoption of race-neutral predictive equations for spirometry in children with sickle cell disease decreased ppFEV1 by 9.5% and caused a threefold increase in subjects with abnormal values.
Observational (n=100)
No
Does the adoption of race-neutral predictive equations alter spirometry results and impairment classification in children with sickle cell disease compared to race-adjusted equations?
The adoption of race-neutral reference equations for spirometry in children with sickle cell disease significantly decreases FEV1 and FVC values and increases the classified severity of lung impairment.
Mean Difference: -9.497
Abstract Background Lung disease is a major cause of morbidity and mortality in children with sickle cell disease (SCD), a condition that is more common in individuals of African American descent. Spirometry is utilized in monitoring lung health. Recently, the American Thoracic Society recommended the use of race‐neutral predictive equations. We aimed to evaluate how the use of race‐neutral equations may affect spirometry results and interpretation in children with SCD. Methods This retrospective study included children aged 5–21 years with SCD followed at Arkansas Children's Hospital (01/01/2000–06/30/2023) who had completed at least one spirometry. Percent predictive (pp) and z ‐score values were calculated using race‐adjusted and race‐neutral predictive equations. Absolute and relative differences were calculated. Percent of subjects with forced expiratory volume in 1 s (FEV 1 ) and forced vital capacity (FVC) with z ‐score <‐1.645 and pp < 80%, and FEV 1 /FVC z ‐score < −1.645 were compared. Severity of impairment based on z ‐score was compared. Results One hundred children completed 460 spirometries. Transitioning from race‐adjusted to race‐neutral equations resulted in mean (SD): a decrease in ppFEV 1 −9.497% (2.8344), FEV 1 z ‐score −0.723 (0.2286), ppFVC −10.08% (3.3440), FVC z ‐score −0.750 (0.2757), FEV 1 /FVC z ‐score −0.057 (0.05461), and an increase in ppFEV 1 /FVC 0.2785 (0.3921). Transitioning from race‐adjusted to race‐neutral equations resulted in an increase of impairment for FVC and FEV 1 and a threefold increase in subjects with abnormal values. Conclusions Adoption of race‐neutral reference equations resulted in a decrease in FEV 1 and FVC values ( z ‐scores and percent predicted) and an increase in severity of impairment.
Ghazala et al. (Tue,) conducted a observational in Sickle cell disease (n=100). Race-neutral predictive equations vs. Race-adjusted predictive equations was evaluated on Percent predictive FEV1 (ppFEV1) (MD -9.497%). Adoption of race-neutral predictive equations for spirometry in children with sickle cell disease decreased ppFEV1 by 9.5% and caused a threefold increase in subjects with abnormal values.