Eliminating race adjustment in lung function tests may alter diagnosis and disability eligibility

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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.

May 20 2024Harvard Medical School At the same time, more white and Hispanic people would be reclassified as having less advanced illness.

Raj Manrai, study senior author, assistant professor of biomedical informatics in the Blavatnik Institute at HMS "Our study aims to quantify the impact of using race to define what is normal variation and what is classified as impairment or disease," said Diao, a fourth-year medical student at HMS and a researcher in the Manrai lab. "We found profound clinical, financial, and occupational implications of how race is operationalized in pulmonary function testing."

Race-neutral estimates, although imperfect, offer an opportunity to move beyond historical assumptions that group-level differences in lung function are natural and benign, the researchers said. The researchers also determined whether the race-based and race-neutral formulas accurately predicted respiratory symptoms such as wheezing and shortness of breath, as well as outcomes such as the need for medical care, risk for developing new lung disease, the risk of dying from lung disease and death from any other cause.

The finding, the researchers said, underscores how the use of race may have long obscured lung disease severity for many Black individuals.

 

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