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

项目摘要 医学上的种族主义对美国的非白人患者造成了重大伤害，其中一种可能是 通过使用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，解释 PFT依赖于种族特定的参考方程，该方程基于平均肺功能 在人口水平上不同种族群体之间存在差异。然而，随着种族作为一种社会 而不是生物构造，种族特定的方程可能不适当地“标准化”较低的观察到的肺 在非白人群体中发挥作用。因此，存在着严重的关切，即种族特定的解释， PFT促进了肺病护理中的种族偏见。随着医学领域更广泛的趋势， 最近从肾小球滤过率计算器中消除了种族，许多人现在呼吁转向 种族中立的方程式重要的是，目前的种族特异性或拟议的种族中立的临床意义， PFT的解释在很大程度上仍然未知。有人认为，种族特有的方程式可能会在种族上产生影响， 通过延迟诊断和治疗、疾病严重程度错误分类以及肺结核发生率降低来进行偏倚治疗 为黑人患者做移植手术然而，很少有数据表明，在一个 种族中立的方法此外，目前还不清楚医生如何理解种族特定的方程或翻译 将结果应用于临床实践。了解种族特异性与种族中性的临床意义 对呼吸系统疾病患者PFT的解释对于告知当前的争论和 引导一个安全和道德公正的过渡到种族中立的方程。 该NRSA应用程序的主要目标是i）发展研究技能，使申请人能够 成为一个成功的，独立的医生科学家和ii）更好地了解如何种族特异性 PFT的解释可能会使肺部疾病的治疗产生偏差。为了实现这一目标，提出了两个新的目标 objective.首先，使用COPD作为模型呼吸系统疾病，我们将估计种族特异性 方法通过研究其对吸入器处方和 优先进行肺移植。其次，我们将评估医生对PFT中种族使用的观点， 在地方和国家一级，以便了解他们对如何利用种族问题的认识， 从参考方程中消除种族的障碍。 本申请的结构旨在为申请人提供必要的培训， 职业生涯作为一个独立资助的研究人员在生物伦理学，种族和肺的交叉工作 疾病通过整合一个跨学科的导师团队，通过健康硕士的正规教育， 科学，以及利用定量和定性方法的研究计划，培训计划将 为申请人提供成功担任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.