A recent study published in JAMA Open Network has revealed significant disparities in asthma diagnosis among children, with a focus on the impact of race-based algorithms in pulmonary function tests. The research underscores the critical need for race-neutral equations to ensure equitable healthcare, particularly when assessing how well the lungs are working.
Historically, lung disease diagnosis, including asthma, has relied on formulas in pulmonary function tests that factored in race. These formulas, stemming from outdated studies, assumed inherent differences in lung function across racial groups. Specifically, they adjusted lung function by 10% to 15% for Black individuals and 4% to 6% for Asian individuals, based on the inaccurate belief that white children possessed “naturally higher” lung function.
This race-based adjustment has had a detrimental effect on accurate asthma diagnosis, especially in Black children. The study, led by Dr. Gurjit Khurana Hershey at Cincinnati Children’s Hospital, revealed that using the older, race-specific equation resulted in a significant underdiagnosis of asthma in this population.
The core finding of the study is that when race-neutral equations, developed by the Global Lung Initiative Network in 2022, are used, significantly more Black children with asthma symptoms, including shortness of breath, are identified as having reduced lung function. Specifically, researchers found that 2.5 to 4 times more Black children were diagnosed with reduced lung function when race-neutral formulas were applied.
The study analyzed data from 1,500 children across three previous studies. The results demonstrated a stark contrast in diagnostic outcomes between the two methods. Using the race-neutral formula led to a 39% change in the assessment of Black children’s lung function, shifting them from a “normal” to a “reduced” classification compared to the race-specific equation.
Furthermore, the race-neutral equation significantly increased the eligibility for further asthma testing. Between 38% and 44% of children who were initially deemed ineligible for additional testing under the race-specific formula became eligible when the race-neutral formula was used. This indicates a substantial improvement in identifying potential asthma cases among Black children. Clinicians can also utilize tools such as a peak flow meter to help determine asthma control.
Crucially, the study found that the race-neutral equation had no significant impact on the lung function assessment of white children. This highlights the discriminatory nature of race-specific formulas, which disproportionately affected Black children. A chest x-ray may also be used to help rule out other potential lung condition causes. A blood test is not typically used to diagnose asthma.
Asthma’s Disproportionate Impact on Black Children
Beyond diagnostic discrepancies, asthma affects Black children with increased severity and prevalence. According to the CDC, Black children are more likely to have asthma than white children. Specifically, in 2019, 11.2% of Black children had asthma, compared to 7.2% of white children. Black children also experience more frequent and severe asthma attacks, leading to higher rates of hospitalization and emergency room visits. In 2018, the asthma hospitalization rate for Black children was nearly three times that of white children. Additionally, Black children are disproportionately affected by environmental factors that exacerbate asthma, such as living in areas with high levels of air pollution, acting as an asthma trigger.
The implications of these findings are profound. The adoption of race-neutral equations in lung function testing has the potential to significantly improve the accuracy of asthma diagnosis, particularly among Black children. This shift can lead to earlier intervention, better management of asthma symptoms, and a reduction in health disparities, improving quality of life and physical activity levels.
Following test results, a physician can create a treatment plan and asthma action plan. This plan may include asthma medicines and a plan to avoid asthma triggers. It is important to monitor side effects of any medication. An individual should be able to take a deep breath when their asthma is under control. It is important to note that this research is focused on asthma, and does not relate to chronic obstructive pulmonary disease (COPD).
The researchers concluded that the universal implementation of race-neutral equations is essential for promoting health equity. By moving away from outdated and racist practices, healthcare providers can ensure that all children, regardless of their race, receive accurate and timely diagnoses. This will contribute to better asthma management and a reduction in asthma-related health disparities.