Author(s): DUQUETTE, A., Institution: UNIVERSITY OF WINDSOR, Country: CANADA, Abstract-ID: 195

INTRODUCTION:
Three very common pulmonary function tests (PFT) using a Spirometer are Forced Vital Capacity (FVC), Slow Vital Capacity (SVC) and Maximum Voluntary Ventilation (MVV). Although these tests are used extensively by medical professionals, some are unaware that “race correction” factors are built into software. In the USA, spirometry software applying correction factors of 10-15% for individuals labelled as “Black” and 4-6% as “Asian” became commonplace [1,2]. During the pandemic, “race corrections” could have potentially caused clinicians to miss diagnoses, or influence treatment plans for Black and Asian patients [2]. Using a correction factor, a Black patient’s FVC had to be 17% lower than a white patient’s for a restrictive pattern to be diagnosed [3]. A recent study that removed the Black racial correction led to a significant increase in the diagnosed prevalence and severity of pulmonary disease [4].
METHODS:
Data from nine participants (n=9, 7M/2F) that self-selected an “African Descendant” (“AD”) ethnicity were examined. To assess the magnitude of the correction factor, their data were output as both “AD” and as “Caucasian” (“C”). It is important to note that the test was not repeated, but one test was simply output twice based on ethnicity. This procedure was repeated for “Indian” (“I”, n= 8, 3M/5F), “North-East Asian” (“NEA”, n=1F), “South-East Asian” (“SEA”, n=5F), “Mexican” (“M”, n=1M), “Hispanic” (“H”, n=2F), and “Korean” (“K”, n=1F) ethnicities. The differences in the percentage of predicted (PP) values were due to ethnicity correction factors.
RESULTS:
When the data of “AD” participants were output as their self-selected ethnicity or as “C” ethnicity, there was a difference in their PP FVC, FEV1, and VC of 16.0%, 14.7%, and 14.4%, respectively. When a participant identified themselves as an “AD”, their FVC represented 104.0% versus 88.0% of their predicted capabilities. Similar findings for FEV1 (100.8% versus 86.1%) and VC (95.1% versus 80.7%), as well as consistency across sex were noted. When self-selected “SEA” participant data was assessed, a similar pattern was seen, just to a lesser degree, with differences in their PP FVC, FEV1, and VC values of 13.6%, 10.6%, and 12.6%, respectively. Racial correction values were not used for “M” or “H” self-selection (0%, 0%, and 0%), while “NEA” corrections led to differences of 2.5%, 1.0% and 2.0%, respectively. “I” and “K” self-selected ethnicities could not be assessed, as the database did not provide the PP values needed for comparison.
CONCLUSION:
These data show that the PP FVC, FEV1, and VC values were not based on participant performance during the PFT test but based on how the data were output from the spirometry equipment. Those that self-selected their ethnicity as “AD” or “SEA” had values that would be mis-represented as better, than if they self-selected their ethnicity as “C”. These racial correction factors could disadvantage Black and Asian patients, leading to misdiagnoses and incorrect treatment plans.