Race-neutral lung assessments in the US will have profound effects, study finds

By Nancy Lapid

(Reuters) – A directive that U.S. doctors ignore race when assessing lung health is likely to have profound effects beyond intended improvements in medical care, such as increased disability payments and disease diagnoses for black patients, while at which time their professional disqualifications will increase, a study found on Sunday.

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

Diagnoses of non-obstructive lung diseases in the US, such as chronic bronchitis, are likely to rise 141% for black patients and fall 69% for white patients, researchers found in the report presented at the annual meeting in San Diego of the American Thoracic Society, the leading society for pulmonary doctors.

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

For hundreds of years, it was assumed that black people had naturally smaller lungs than white people, meaning that a given amount of air moving in and out of the lungs may 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 lung function test, were therefore born from the idea that “normal” differs by race.

Experts now believe that smaller lung capacities in some non-white populations may be due to environmental exposure 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 these inequities. The guideline advising the use of breed-neutral formulas was issued last year by the Thoracic Society.

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

The results of the new equations can be complex. If they reveal more severe lung involvement, surgeons may be less likely to recommend potentially curative surgeries, but this may prevent surgical complications in patients who are at higher risk than previously recognized, 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 the eligibility thresholds for treatments and socioeconomic benefits, said Dr. Meredith McCormack of the School of Johns Hopkins University Medicine. in Baltimore, Maryland, who co-authored an accompanying editorial.

Analysis of study data on more than 369,000 U.S. and U.K. residents found that the new formulas would likely reclassify 12.5 million U.S. patients as having or not having varying degrees of respiratory distress.

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

Changes in patients’ classifications could affect their eligibility for trials of new treatments, researchers said.

The impact on medical outcomes and whether the advantages outweigh the disadvantages won’t be known for years, said Dr. David Kaminsky of the University of Vermont Larner School of Medicine in Burlington, co-author of the editorial.

“We’ll have to wait and see,” Kaminsky said.

(Reporting by Nancy Lapid; Editing by Michele Gershberg and William Mallard)