Initiatives to Eliminate Race-Based Lung Function Assessments

Efforts are underway to reform lung function assessments by eliminating race-based criteria, a move that has gained traction among medical professionals and researchers. A collaborative group, including physicians from various institutions, has highlighted the need to reevaluate the methodologies used in measuring occupational impairment, which significantly affects disability determinations and worker's compensation eligibility.

In a recent publication in the New England Journal of Medicine, the team discussed the historical context of how race has been utilized in pulmonary function testing, which often leads to miscalculations of lung function impairment. Such inaccuracies can result in unjust evaluations impacting individuals' compensation and care.

The lead author of the study emphasized that race has long been misapplied as an indicator of biological differences in medical research and practice, particularly in the reference equations used to assess lung function. The American Thoracic Society and the European Respiratory Society have already issued guidelines opposing the use of race in these equations. However, significant challenges remain in fully implementing these recommendations across clinical and evaluative contexts.

After proposing the removal of race from pulmonary function reference equations, the group recognized the necessity of addressing implementation strategies not only in clinical settings but also in areas concerning disability evaluations. Collaboration with the American Medical Association (AMA) has been instrumental in pushing for these modifications.

The AMA Guides, which serve as a standard for evaluating worker's compensation claims across many states and international organizations, currently still recommend race-based reference equations in spirometry tests, which assess lung function and capacity. The authors of the recent publication pointed out flaws in the foundational studies that supported race-adjusted spirometry interpretations. Many of these studies attributed differences in lung function solely to biological factors without considering the social and environmental influences that significantly impact health outcomes.

To ensure equitable evaluations in the future, the authors propose a comprehensive review of the entire framework surrounding pulmonary impairment assessments, beyond just the choice of reference equations. This includes addressing the potential harms caused to patients whose lung function impairments--and consequently their disability ratings or worker's compensation benefits--may have been inaccurately assessed due to race-based criteria.

In light of these findings, institutions such as Mass General Brigham and the University of California, San Francisco, have already adopted a race-neutral approach by utilizing the Global Lung Function Initiative reference equation. This shift aligns with the guidelines set forth by the American Thoracic Society, with other healthcare organizations also moving towards similar practices.

The ongoing efforts to eliminate race-based assessments from lung function testing highlight a crucial step toward achieving fairness and accuracy in medical evaluations. The upcoming revisions to the AMA Guides are anticipated to reflect these changes, although the authors caution that continued work will be necessary to ensure equitable treatment and assessment for all patients.