• Elizabeth M Kiefer, John L Hankinson, and R Graham Barr.
• Division of General Internal Medicine, Department of Medicine, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, New York, USA.
• Am. J. Epidemiol. 2011 Feb 15;173(4):376-87.

AbstractCurrent guidelines recommend separate spirometry reference equations for whites, African Americans, and Mexican Americans, but the justification for this recommendation is controversial. The authors examined the statistical justification for race/ethnic-specific reference equations in adults in the Third National Health and Nutrition Examination Survey (1988-1994) and the Multi-Ethnic Study of Atherosclerosis Lung Study (2000-2006). Spirometry was measured following American Thoracic Society guidelines. "Statistical justification" was defined as the presence of effect modification by race/ethnicity among never-smoking participants without respiratory disease or symptoms and was tested with interaction terms for race/ethnicity (× age and height) in regression models. There was no evidence of effect modification by race/ethnicity for forced expiratory volume in 1 second, forced vital capacity, or the forced expiratory volume in 1 second/forced vital capacity ratio among white, African-American, and Mexican-American men or women on an additive scale or a log scale. Interaction terms for race/ethnicity explained less than 1% of variability in lung function. The mean lung function for a given age, gender, and height was the same for whites and Mexican Americans but was lower for African Americans. Findings were similar in the Multi-Ethnic Study of Atherosclerosis Lung Study. The associations of age and height with lung function are similar across the 3 major US race/ethnic groups. Multiethnic rather than race/ethnic-specific spirometry reference equations are applicable for the US population.

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