Comparison of Race-Neutral Versus Race-Specific Spirometry Equations for Evaluation of Child Asthma

Race-based estimates of pulmonary function in children could influence the evaluation of asthma in children from racial and ethnic minoritized backgrounds. To determine if race-neutral (Global Lung Function Initiative [GLI]-Global) versus race-specific (GLI-Race-Specific) reference equations differentially impact spirometry evaluation of childhood asthma. The 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 FEV, FVC, and FEV/FVC -scores. We used multivariable logistic models to evaluate associations between -scores calculated with different equations and asthma diagnosis, emergency department visits, and hospitalization. For Black children, the GLI-Global versus GLI-Race-Specific equations estimated significantly lower -scores for FEV and FVC but similar values for FEV/FVC, thus increasing the proportion of children classified with low FEV by 14%. Although both equations yielded strong inverse relationships between FEV and FEV/FVC -scores and asthma outcomes, these relationships varied across racial and ethnic groups ( < 0.05). For any given FEV or FEV/FVC -score, asthma diagnosis and emergency department visits were higher among Black and Hispanic than among White children ( < 0.05). For FEV, GLI-Global equations estimated asthma outcomes that were more uniform across racial and ethnic groups. Parent-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.