Assessing Racial Bias in Pulmonary Medicine from the Interpretation of Pulmonary Function Tests

项目摘要 在美国，医学上的种族主义对非白人患者造成了重大伤害，其中一种方式可能是 发生是通过使用带有种族偏见的临床算法，如肺功能测试(PFT)。PFT是 广泛用于呼吸系统疾病的诊断、治疗和相关护理。目前，对 PFTs依赖于种族特定的参考方程，该方程基于平均肺功能的观察 在人口水平上，不同的种族群体之间存在差异。然而，随着对种族作为一种社会因素的认识 与生物构造不同，特定于种族的方程可能会不适当地将观察到的下部肺“正常化”。 在非白人群体中发挥作用。因此，存在着严重的担忧，即针对种族的解释 PFTs在肺部疾病的护理中助长了种族偏见。遵循更广泛的医学趋势，如 最近从肾小球滤过率计算器中消除了种族，许多人现在呼吁将其转变为 种族中立的方程。重要的是，当前种族特定或拟议的种族中立的临床意义 对自由贸易协定的解释在很大程度上仍然不为人知。有人建议，特定于种族的方程式可能在种族上 诊断和治疗延迟、疾病严重程度分类错误和肺部发病率下降带来的偏见护理 黑人患者的移植。然而，几乎没有数据表明这些结果将在 种族中立的方法。此外，还不知道医生如何理解特定种族的方程式或翻译 将结果应用于临床实践。了解特定种族与非特定种族的临床含义 对呼吸系统疾病患者的PFT的解释对于指导当前的辩论和 引导安全和道德公正地过渡到种族中立的方程式。 此NRSA申请的主要目标是：i)发展研究技能，使申请者能够 成为一名成功的、独立的内科科学家和ii)更好地理解特定于种族的 对PFTs的解释可能会对肺部疾病的治疗产生偏见。为实现这一目标提出了两个新的目标 目标。首先，使用COPD作为呼吸道疾病的模型，我们将估计一个特定种族的影响 通过研究其对吸入剂处方和治疗效果的影响，对COPD患者的治疗产生影响 优先考虑肺移植。第二，我们将评估医生对在PFTs中使用种族的看法 地方和国家两级，以便了解他们对种族如何被利用的认识，并确定潜力 从参考方程式中消除种族障碍。 本申请表旨在为申请者提供必要的培训，使其能够获得 作为一名独立资助的研究人员，在生物伦理学、种族和肺病的交叉点工作 疾病。通过整合跨学科的指导团队，通过健康硕士的正式教育 科学，以及利用定量和定性方法的研究计划，培训计划将 为申请者提供成功成为独立调查员所需的技能。

Project Summary Racism in medicine causes significant harm to non-White patients in the U.S., and one way this may occur is via the use of racially biased clinical algorithms such as pulmonary function tests (PFTs). PFTs are widely used for the diagnosis, treatment, and related care of respiratory diseases. Currently, interpretation of PFTs relies on race-specific reference equations, which are based on the observation that average lung function varies between different racial groups on a population level. However, with the recognition of race as a social rather than biological construct, race-specific equations may inappropriately ‘normalize’ the lower observed lung function in non-White populations. As such, there exists significant concern that a race-specific interpretation of PFTs promotes racial bias in the care of pulmonary disease. Following a broader trend in medicine as seen with the recent elimination of race from the Glomerular Filtration Rate calculator, many are now calling for a shift to race-neutral equations. Importantly, the clinical implications of the current race-specific or proposed race-neutral interpretations of PFTs remain largely unknown. It has been suggested that race-specific equations may racially bias care via delayed diagnosis and treatment, misclassification of disease severity, and decreased rates of lung transplantation for Black patients. However, there are little data on how these outcomes would change under a race-neutral approach. Further, it is unknown how physicians understand race-specific equations or translate the results into clinical practice. Understanding the clinical implications of a race-specific versus race-neutral interpretation of PFTs among patients with respiratory disease is critical to both informing the current debate and guiding a safe and ethically just transition to race-neutral equations. The main goals of this NRSA application are i) to develop research skills that will allow the applicant to become a successful, independent physician scientist and ii) to better understand how a race-specific interpretation of PFTs may bias treatment of pulmonary disease. Two novel aims are proposed to achieve this objective. First, using COPD as a model respiratory disease, we will estimate the impact that a race-specific approach has on the treatment of patients with COPD by investigating its effect on both inhaler prescriptions and priority for lung transplantation. Second, we will assess physicians’ perspectives on the use of race in PFTs at both a local and national level in order to understand their awareness of how race is used and to identify potential barriers to the elimination of race from reference equations. This application has been structured to provide the applicant with the necessary training to pursue a career as an independently funded researcher working at the intersection of bioethics, race, and pulmonary disease. By incorporating an inter-disciplinary mentorship team, formal education via a Masters in Health Science, and a research plan utilizing both quantitative and qualitative methodologies, the training plan will provide the applicant skills necessary to succeed as an independent investigator.