US race-neutral lung assessments to have profound effects, study finds

A guideline for U.S. doctors to ignore race in assessing lung health will likely have profound effects beyond the intended improvements in medical care, such as increasing disability payments and disease diagnoses for Black patients while boosting their job disqualifications, a study found on Sunday.

Asian and Black patients will move forward on U.S. lung transplant waiting lists, with 4.3 fewer days of expected wait time, while Hispanic and white candidates will move back, having to wait 1.1 days longer on average, according to a report of the study in the New England Journal of Medicine.

U.S. diagnoses of nonobstructive lung disorders, such as chronic bronchitis, will likely jump 141% for Black patients and fall 69% for white patients, the researchers found in the report presented at the annual meeting in San Diego of the American Thoracic Society, the premier society for lung doctors.

Annual disability payments for Black military veterans will likely rise by more than $1 billion and fall by $500 million for white veterans, the researchers estimated.

Black people had been assumed for hundreds of years to naturally have smaller lungs than white people, meaning a given amount of air going into and out of the lungs could appear to show impaired lung function in white patients and normal function in Black patients.

Traditional race-based equations for interpreting the results of spirometry, the most commonly used type of pulmonary function test, therefore grew from the idea that "normal" differs by race.

Experts now believe smaller lung capacities in some nonwhite populations may be due to environmental exposures to pollution, poor nutrition, and other risk factors.

New, race-neutral equations for determining lung function - taking into account height, age and gender but not race - aim to help correct such inequities. The guideline advising use of race-neutral formulas was issued last year by the thoracic society.

These equations "offer an opportunity to move beyond crude proxies like race and the associated assumption that these differences in lung function are benign," said Dr. Raj Manrai of Harvard Medical School in Boston, the senior author of the study.

The results of the new equations could be complex. If they reveal more severe lung impairment, surgeons might be less likely to recommend potentially curative surgeries, but this may prevent surgical complications in patients who are at higher risk than previously recognized, the researchers found.

The new research is the first large study to quantify the likely effects of how the new equations will shift millions of people to one side or another of eligibility thresholds for treatments and socioeconomic benefits, said Dr. Meredith McCormack of the Johns Hopkins University School of Medicine in Baltimore, Maryland, who co-authored an accompanying editorial.

The study's analysis of data on more than 369,000 U.S. and British residents found the new formulas would likely reclassify 12.5 million U.S. patients as having or not having various degrees of breathing impairment.

The new equations will reclassify medical impairment ratings for 8.16 million people; eligibility for jobs, such as firefighter, requiring a certain level of lung function for 2.28 million; grading of chronic obstructive pulmonary diseases for 2.05 million; and military disability compensation eligibility for 413,000, the researchers estimated.

Changes to patients' classifications could affect their eligibility for trials of new treatments, the researchers said.

The impact on medical outcomes and whether the advantages outweigh the disadvantages will not be known for years, said Dr. David Kaminsky of the University of Vermont Larner College of Medicine in Burlington, who co-authored the editorial.

"We’re going to have to wait and see," Kaminsky said.