RATIONALE Race-based estimates of pulmonary function in children could influence the evaluation of asthma in children from racial and ethnic minoritized backgrounds. OBJECTIVES To determine if race-neutral (GLI-Global) versus race-specific (GLI-Race-Specific) reference equations differentially impact spirometry evaluation of childhood asthma. METHODS 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 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 RESULTS For 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. CONCLUSIONS 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.

中文翻译：

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用于评估儿童哮喘的种族中立与种族特异性肺活量测定方程的比较。


基本原理 基于种族的儿童肺功能估计可能会影响来自种族和少数民族背景的儿童对哮喘的评估。目的 确定种族中立 （GLI-Global） 与种族特定 （GLI-Race-Specific） 参考方程是否对儿童哮喘的肺活量测定评估产生差异影响。方法 该分析包括来自美国 8,719 个队列的 5 至 <12 岁儿童，按父母报告的种族和民族分组。我们分析了这些方程如何影响 1 秒用力呼气容积 （FEV1） 、用力肺活量 （FVC） 和 FEV1/FVC z 评分。我们使用多变量 logistic 模型来评估用不同方程计算的 z 分数与哮喘诊断、急诊科 （ED） 就诊和住院之间的关联。测量和主要结果 对于黑人儿童，GLI-Global vs. Race-Specific 方程估计 FEV1 和 FVC 的 z 分数显着降低，但 FEV1/FVC 的值相似，因此被归类为低 FEV1 的儿童比例增加了 14%。虽然这两个方程式在 FEV1 和 FEV1/FVC z 评分与哮喘结局之间产生了很强的负关系，但这些关系因种族和民族而异 （p<0.05）。对于任何给定的 FEV1 或 FEV1/FVC z 评分，黑人和西班牙裔儿童的哮喘诊断和 ED 就诊率高于白人儿童 （p<0.05）。对于 FEV1，GLI-Global 方程估计的哮喘结局在种族和族裔群体之间更加一致。结论 父母报告的种族和民族影响肺功能与哮喘结局之间的关系。 我们的数据显示，在评估儿童哮喘方面，种族特定方程式没有优势，并且种族特异性方程式可能会掩盖弱势儿童的肺损伤，这强烈支持使用种族中立方程。