• Amy L Non, Xiuhong Li, Miranda R Jones, Emily Oken, Tina Hartert, Nathan Schoettler, Diane R Gold, Sima Ramratnam, Eric M Schauberger, Kelan Tantisira, Leonard B Bacharier, Douglas J Conrad, Kecia N Carroll, Flory L Nkoy, Heike Luttmann-Gibson, Frank D Gilliland, Carrie V Breton, Meyer Kattan, Robert F Lemanske, Augusto A Litonjua, Cythia T McEvoy, Katherine Rivera-Spoljaric, Christian Rosas-Salazar, JosephChristine L MCLMHenry Ford Health System, Biostatistics and Research Epidemiology, Detroit, Michigan, United States., Meredith Palmore, Patrick H Ryan, Ganesa Wegienka, Alexandra R Sitarik, Anne Marie Singh, Rachel L Miller, Edward M Zoratti, Dennis Ownby, Carlos A Camargo, Judy L Aschner, Annemarie Stroustrup, Shohreh F Farzan, Margaret R Karagas, Daniel J Jackson, James E Gern, and ECHO Cohort Consortium.
• University of California San Diego, Anthropology, La Jolla, California, United States; alnon@ucsd.edu.
• Am. J. Respir. Crit. Care Med. 2024 Dec 6.

RationaleRace-based estimates of pulmonary function in children could influence the evaluation of asthma in children from racial and ethnic minoritized backgrounds.ObjectivesTo determine if race-neutral (GLI-Global) versus race-specific (GLI-Race-Specific) reference equations differentially impact spirometry evaluation of childhood asthma.MethodsThe analysis included 8,719 children aged 5 to <12 years from 27 cohorts across the United States grouped by parent-reported race and ethnicity. We analyzed how the equations affected forced expiratory volume in 1 second (FEV1), forced vital capacity (FVC), and FEV1/FVC z-scores. We used multivariable logistic models to evaluate associations between z-scores calculated with different equations and asthma diagnosis, emergency department (ED) visits, and hospitalization.Measurements And Main ResultsFor Black children, the GLI-Global vs. Race-Specific equations estimated significantly lower z-scores for FEV1 and FVC but similar values for FEV1/FVC, thus increasing the proportion of children classified with low FEV1 by 14%. While both equations yielded strong inverse relationships between FEV1 and FEV1/FVC z-scores and asthma outcomes, these relationships varied across racial and ethnic groups (p<0.05). For any given FEV1 or FEV1/FVC z-score, asthma diagnosis and ED visits were higher among Black and Hispanic versus White children (p<0.05). For FEV1, GLI-Global equations estimated asthma outcomes that were more uniform across racial and ethnic groups.ConclusionsParent-reported race and ethnicity influenced relationships between lung function and asthma outcomes. Our data show no advantage to race-specific equations for evaluating childhood asthma, and the potential for race-specific equations to obscure lung impairment in disadvantaged children strongly supports using race-neutral equations.

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