ArticleEClinicalMedicine2021
Prognostic implications of differences in forced vital capacity in black and white US adults: Findings from NHANES III with long-term mortality follow-up.
Article in EClinicalMedicine, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 21 papers, 1 of them a synthesis that pooled it.
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Who cites it
21 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Guideline
- A cohort study of forced vital capacity, airway obstruction, and survival in the multinational Burden of Obstructive Lung Disease study.International journal of epidemiology · 2026Article
- The Effect of Pulmonary Function Test Reference Equations on Classification of Restrictive Lung Disease Severity in Systemic Sclerosis.Arthritis care & research · 2026Article
- Geographical variation in lung function: Results from the multicentric cross-sectional BOLD study.Pulmonology · 2025Article
- Tacrolimus as first-line therapy in a US cohort of idiopathic inflammatory myopathies related interstitial lung disease.Rheumatology (Oxford, England) · 2025Article
- The association between social determinants of health and all-cause, cardiovascular mortality in US rheumatoid arthritis: a cohort study of NHANES.BMC public health · 2025Article
- Race-Neutral Equations and Pulmonary Function Test Interpretation in Two Pediatric Cohorts.The Journal of pediatrics · 2024Article
- Rethinking the Role of Race in Lung Function: The Shift to Race-Neutral Spirometry Interpretation.Mayo Clinic proceedings · 2024Article
- Application of Global Lung Function Initiative Global Spirometry Reference Equations across a Large, Multicenter Pulmonary Function Lab Population.American journal of respiratory and critical care medicine · 2024Article
- Reply to: [Letter to the Editor].Health equity · 2024Article
- Early Evidence of Chronic Obstructive Pulmonary Disease Obscured by Race-Specific Prediction Equations.American journal of respiratory and critical care medicine · 2024Article
- The Time for Race-Neutral Pulmonary Function Norms is Now.Health equity · 2024Article
- Race-Specific Spirometry Equations Do Not Improve Models of Dyspnea and Quantitative Chest CT Phenotypes.Chest · 2023Article
- Use of the Spirometric "Fixed-Ratio" Underdiagnoses COPD in African-Americans in a Longitudinal Cohort Study.Journal of general internal medicine · 2023Article
- Global, Race-Neutral Reference Equations and Pulmonary Function Test Interpretation.JAMA network open · 2023Article
- Race and Ethnicity in Pulmonary Function Test Interpretation: An Official American Thoracic Society Statement.American journal of respiratory and critical care medicine · 2023Article
- Exploring the intersection of structural racism and ageism in healthcare.Journal of the American Geriatrics Society · 2022Article
- Comparing Racial Differences in Emphysema Prevalence Among Adults With Normal Spirometry: A Secondary Data Analysis of the CARDIA Lung Study.Annals of internal medicine · 2022Observational
- Is There a Role for Using Race-Specific Reference Equations? Yes and No.American journal of respiratory and critical care medicine · 2022Article
- Reconsidering the Utility of Race-Specific Lung Function Prediction Equations.American journal of respiratory and critical care medicine · 2022Observational
Corrections and comments
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Authors and funding
5 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundBecause Forced Vital Capacity (FVC) is reduced in Black relative to White Americans of the same age, sex, and height, standard lung function prediction equations assign a lower "normal" range for Black patients. The prognostic implications of this race correction are uncertain.
methodsWe analyzed 5,294 White and 3,743 Black participants age 20-80 in NHANES III, a nationally-representative US survey conducted 1988-94, which we linked to the National Death Index to assess mortality through December 31, 2015. We calculated the FVC-percent predicted among Black and White participants, first applying NHANES III White prediction equations to all persons, and then using standard race-specific prediction equations. We used Cox proportional hazard models to calculate the association between race and all-cause mortality without and with adjustment for FVC (using each FVC metric), smoking, socioeconomic factors, and comorbidities.
findingsBlack participants' age- and sex-adjusted mortality was greater than White participants (HR 1.46; 95%CI:1.29, 1.65). With adjustment for FVC in liters (mean 3.7 L for Black participants, 4.3 L for White participants) or FVC percent-predicted using White equations for everyone, Black race was no longer independently predictive of higher mortality (HR∼1.0). When FVC-percent predicted was "corrected" for race, Black individuals again showed increased mortality hazard. Deaths attributed to chronic respiratory disease were infrequent for both Black and White individuals.
interpretationLower FVC in Black people is associated with elevated risk of all-cause mortality, challenging the standard assumption about race-based normal limits. Black-White disparities in FVC may reflect deleterious social/environmental exposures, not innate differences.
fundingNo funding.
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