LUNG HEALTH DISPARITIES
Black patients are 1.5x more likely to receive an asthma diagnosis, 5x more likely to visit an emergency department for asthma, and 3x more likely to die from an asthma related cause.
Black patients are often diagnosed later or underdiagnosed with COPD, but also face greater disease severity, including more ER visits and hospitalizations.
IMPACT OF THE ALGORITHM
How does the algorithm work?
A spirometry test measures the rate and amount of air that exits the lungs when a patient breathes in and out of a mouthpiece connected to a spirometry machine. Healthcare professionals measure the forced expiratory value (FEV) with a spirometry test. It is calculated based on how much air a patient breathes in and out, and how fast the patient exhales – FEV1 is a commonly used value showing exhalation in 1 second. The FEV is then expressed as a percentage to measure the maximum amount of air expired during a breath. The lower the FEV, the more obstructed the lung. FEV is an important parameter for detection of conditions like asthma, COPD, and cystic fibrosis.
FEV results are compared to values using the Global Lung Initiative (GLI) calculator. This calculator estimates what a person’s lung function should look like based on basic information like age, height, sex, and ethnicity (race-neutral, Caucasian, African-American, Northeast Asian, Southeast Asian, Other/mixed).
The GLI calculator provides predicted spirometer values given the patient’s input factors to use as comparison. The actual and predicted values are compared by producing a Z score. A more negative Z score means the lung function is lower than the predicted value.
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If FEV1=
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≥80% is GOLD 1 (mild)
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50-79% is GOLD 2 (moderate)
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30-49% is GOLD 3 (severe)
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<30% is GOLD 4 (very severe)
How does the inclusion of race impact disparities?
Including race/ethnicity in the GLI calculator leads to underdiagnosis and incorrect staging of pulmonary diseases in non-white patients. This can delay necessary and effective treatments and lead to worse health outcomes.
Removing race improves diagnosis, staging, monitoring, and treatment in Black children and adults.
What is the current algorithm?
In 2022, the GLI calculator was revised and the new “GLI Global” calculator now weights all races/ethnicities equally. Today, many spirometers adjust for race. In April 2023, the American Thoracic Society (ATS) stated that race should no longer be factored into spirometry tests and interpretation of results.
COALITION IMPACT
All health systems participating in the Coalition to Eliminate Race-Based Medicine have updated their GLI calculators to remove race as a variable.