• Elizabeth A Regan, Melissa E Lowe, Barry J Make, Jeffrey L Curtis, Quan Grace Chen, Michael H Cho, James L Crooks, Katherine E Lowe, Carla Wilson, James K O'Brien, Gabriela R Oates, Arianne K Baldomero, Gregory L Kinney, Kendra A Young, Alejandro A Diaz, Surya P Bhatt, Meredith C McCormack, Nadia N Hansel, Victor Kim, Nicole E Richmond, Gloria E Westney, Marilyn G Foreman, Douglas J Conrad, Dawn L DeMeo, Karin F Hoth, Hannatu Amaza, Aparna Balasubramanian, Julia Kallet, Shandi Watts, Nicola A Hanania, John Hokanson, Terri H Beaty, James D Crapo, Edwin K Silverman, Richard Casaburi, and Robert Wise.
• Department of Medicine, National Jewish Health, Denver, CO, USA. Regane@NJHealth.org.
• J Gen Intern Med. 2023 Oct 1; 38 (13): 298829972988-2997.

BackgroundCOPD diagnosis is tightly linked to the fixed-ratio spirometry criteria of FEV1/FVC < 0.7. African-Americans are less often diagnosed with COPD.ObjectiveCompare COPD diagnosis by fixed-ratio with findings and outcomes by race.DesignGenetic Epidemiology of COPD (COPDGene) (2007-present), cross-sectional comparing non-Hispanic white (NHW) and African-American (AA) participants for COPD diagnosis, manifestations, and outcomes.SettingMulticenter, longitudinal US cohort study.ParticipantsCurrent or former smokers with ≥ 10-pack-year smoking history enrolled at 21 clinical centers including over-sampling of participants with known COPD and AA. Exclusions were pre-existing non-COPD lung disease, except for a history of asthma.MeasurementsSubject diagnosis by conventional criteria. Mortality, imaging, respiratory symptoms, function, and socioeconomic characteristics, including area deprivation index (ADI). Matched analysis (age, sex, and smoking status) of AA vs. NHW within participants without diagnosed COPD (GOLD 0; FEV1 ≥ 80% predicted and FEV1/FVC ≥ 0.7).ResultsUsing the fixed ratio, 70% of AA (n = 3366) were classified as non-COPD, versus 49% of NHW (n = 6766). AA smokers were younger (55 vs. 62 years), more often current smoking (80% vs. 39%), with fewer pack-years but similar 12-year mortality. Density distribution plots for FEV1 and FVC raw spirometry values showed disproportionate reductions in FVC relative to FEV1 in AA that systematically led to higher ratios. The matched analysis demonstrated GOLD 0 AA had greater symptoms, worse DLCO, spirometry, BODE scores (1.03 vs 0.54, p < 0.0001), and greater deprivation than NHW.LimitationsLack of an alternative diagnostic metric for comparison.ConclusionsThe fixed-ratio spirometric criteria for COPD underdiagnosed potential COPD in AA participants when compared to broader diagnostic criteria. Disproportionate reductions in FVC relative to FEV1 leading to higher FEV1/FVC were identified in these participants and associated with deprivation. Broader diagnostic criteria for COPD are needed to identify the disease across all populations.© 2023. The Author(s), under exclusive licence to Society of General Internal Medicine.

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