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Removing Race Correction From Lung Function Test Changes Clinical Management

Removal of race correction was tied to a significant reduction in the estimation of lung function for African Americans

By Lori Solomon HealthDay Reporter

WEDNESDAY, Aug. 30, 2023 (HealthDay News) — Removal of race correction from pulmonary function tests (PFTs) may change surgical management of lung cancer in African American patients, according to a study published Aug. 16 in JAMA Surgery.

Sidra N. Bonner, M.D., M.P.H., from the University of Michigan in Ann Arbor, and colleagues aimed to identify how many hospitals providing lung cancer surgery use race correction, examined the association of race correction with predicted lung function, and tested the effect of hypothetical vignettes on surgeons’ treatment recommendations for African American patients. The analysis included data from 515 African American patients who underwent lung cancer resection between Jan. 1, 2015, and Sept. 31, 2022.

The researchers found that 15 of 16 hospitals performing lung cancer resection for African American patients in Michigan reported using race correction, corresponding to 91.8 percent of African American patients having race-corrected PFTs. If race-neutral equations had been used, the percent predicted preoperative forced expiratory volume in 1 second (FEV1) and postoperative FEV1 would have decreased by 9.2 percent (P < 0.001) and 7.6 percent (P < 0.001), respectively. Among 225 cardiothoracic surgeons who completed treatment recommendations based on a randomized vignette, surgeons randomly assigned to the vignette with African American race-corrected PFTs were more likely to recommend lobectomy (79.2 percent) versus surgeons randomly assigned to the other race or multiracial-corrected vignette (61.7 percent; P = 0.02) or race-neutral PFTs (52.8 percent; P = 0.001).

“It is important that race-correction in spirometry tests is removed given that it is based on the flawed concept of race as a biological factor,” Bonner said in a statement. “For African Americans with lung cancer being evaluated for surgery, this may exacerbate existing disparities in lung cancer care.”

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