by NEW YORK (AP) – Racial bias built into a common medical test for lung function is likely leading to fewer black patients receiving treatment for breathing problems, suggests a study published Thursday.
Up to 40% more black male patients in the study could have been diagnosed with breathing problems if the current diagnostic aid software was changed, the study said.
Doctors have long debated the potential problems caused by race-based assumptions that are built into diagnostic software. This study, published in JAMA Network Open, offers one of the first real-world examples of how the problem can affect the diagnosis and treatment of lung patients, said Dr. Darshali Vyas, a pulmonary care physician at Massachusetts General Hospital.
The results are “exciting” to be published, but it’s also “what we’d hope for” by setting aside race-based calculations, said Vyas, author of an influential 2020 New England Journal of Medicine paper that cataloged examples of how race data-based assumptions are used in physicians’ decision-making about patient care.
For centuries, some physicians and others have believed that there are natural racial differences in health, including that black people’s lungs are innately worse than white people’s. That assumption has ended up in modern guidelines and algorithms for assessing risk and deciding on further care. Test results have been adjusted to account for — or “correct for” — the patient’s race or ethnicity.
An example beyond lung function is a heart failure risk rating system that categorizes black patients as lower risk and less likely to need referral for special cardiac care. Another is an equation used in determining kidney function that creates higher kidney function estimates in black patients.
The new study focused on a test to determine how much and how quickly a person can inhale and exhale. It is usually done using a spirometer – a device with a mouthpiece attached to a small machine.
After the test, doctors obtain a report that was run through computer software and scores the patient’s breathing capacity. It helps indicate whether a patient has restrictions and needs further testing or care for things like asthma, chronic obstructive pulmonary disease, or lung scarring due to exposure to air pollutants.
Algorithms that adjust for race raise the threshold for diagnosing a problem in black patients and may make them less likely to start taking certain medications or be referred for medical procedures or even lung transplants, Vyas said.
While doctors also look at symptoms, lab tests, x-rays, and family histories of breathing problems, lung function testing can be an important part of diagnoses, “especially when patients are borderline,” said Dr. Albert Rizzo, medical director at the American Lung Association.
The new study looked at more than 2,700 black men and 5,700 white men tested by physicians at the University of Pennsylvania Health System between 2010 and 2020. based algorithm compared to a new algorithm.
The researchers concluded that there would be nearly 400 additional cases of lung obstruction or compromise in black men with the new algorithm.
Earlier this year, the American Thoracic Society, which represents physicians who care for the lungs, issued a statement recommending replacing race-focused adjustments. But the organization also called for more research, including on the best way to modify the software and whether making a change could inadvertently lead to overdiagnosis of lung problems in some patients.
Vyas noted that some other algorithms have already been changed to rule out race-based assumptions, including one for pregnant women that predicts risks of vaginal delivery if the mother has already had a C-section.
Changing the lung testing algorithm can take longer, Vyas said, especially if different hospitals use different versions of race-adjustment software and procedures.
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