Impact of race-based lung function algorithm

June 26, 2024

We’ve long known that race-based algorithms that use different “normals” based on race can lead to discrimination. For instance, benchmarks that overestimated Black people’s kidney function led to many Black people failing to qualify for kidney transplants until they were so sick that they would likely not survive. Eliminating race from these formulas generally leads to more equitable health outcomes.

A study in the New England Journal of Medicine demonstrated the importance of removing adjustments for race in lung function tests. The researchers used data from multiple large databases, including the UK Biobank study and the US National Health and Nutrition Examination Survey (NHANES) survey, to calculate the lung function of Asian, Black, Hispanic and White people using an older race-based formula and a newer race-neutral formula.

They found that the race-neutral formulas were more likely to demonstrate lung damage in Black people. This has substantial implications in terms of:

• Disability payments

Over 200,000 Black veterans in the United States would be eligible for over $1.1 billion of annual disability payments.

• Lung transplant eligibility

Black and Asian people with severe lung disease advanced on the lung transplant lists, while White and Hispanic people were slightly lower on these lists.

• Occupational eligibility

The number of Black people with lung function that would make them ineligible to be firefighters would double (and the number of White people eligible to be firefighters would increase.)

The researchers chose to use percentiles to determine eligibility for disability or occupation, so any change of eligibility for one race would cause an offsetting change in other races. For occupational eligibility, resetting eligibility requirements based on a threshold rather than a percentile could mean that race neutral formulas would increase the number of White people who could become firefighters, rather than decrease eligibility for Black people.

Implications for employers:

• Employers that use lung function tests to determine occupational eligibility or disability can convert to race-neutral test formulas to avoid discrimination.

• Employers can ask carriers to provide reporting on racial and other disparities which can help identify and ultimately remedy structural discrimination.

Thanks for reading.  You can find previous posts in the Employer Coverage archive

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Illustration by Dall-E

Tomorrow: Thursday Shorts, including stem cell fraud, COVID-19 boosters, narcan, and remote radiation oncology consultations.