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A team of physicians and researchers has successfully advocated for the removal of race from lung function testing in the American Medical Association (AMA) Guides to the Evaluation of Permanent Impairment.This change is meaningful as these Guides are widely used to determine disability and worker’s compensation eligibility.The researchers highlight that race has historically been used inappropriately as a proxy for biological traits in medical evaluations, including lung function testing.This practice, which has been criticized by national guidelines from the American Thoracic Society and European Respiratory Society, has led to potential underestimation of lung function impairment in certain racial groups. The original studies that established race-adjusted spirometry frequently enough focused on biological explanations for racial differences while overlooking environmental and social factors that impact lung health.
The proposed modifications to the AMA Guides will be implemented in the next update, but the authors stress that further complex solutions are needed to ensure equitable pulmonary evaluations in the future. They also emphasize the importance of addressing past harms caused by race-based equations, particularly for individuals whose disability ratings or compensation may have been unfairly affected.
Several healthcare systems, including Mass general Brigham and UCSF, have already begun using race-neutral equations for pulmonary function testing in line with the new recommendations.
