Evidence map›Paper›PMID 38767252›Full record

ArticleThe New England journal of medicine2024

Implications of Race Adjustment in Lung-Function Equations.

James A Diao, Yixuan He, Rohan Khazanchi, Max Jordan Nguemeni Tiako, Jonathan I Witonsky, Emma Pierson, Pranav Rajpurkar, Jennifer R Elhawary, Luke Melas-Kyriazi, Albert Yen and 9 more

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Article in The New England journal of medicine, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 57 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
57citing papers in PubMed, 1 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

57 citing papers in PubMed, 1 synthesis or guideline pooled it.

  1. Pooled it
  2. Trial
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  4. Review
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  7. Review
  8. Article
  9. Associations between genetic ancestry and allergic outcomes at 10 years among Black children.Annals of allergy, asthma & immunology : official publication of the American College of Allergy, Asthma, & Immunology · 2026
    Article
  10. Article
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  13. Restoring time lost to race-based medicine.Nature reviews. Urology · 2026
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4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

19 authors.

James A DiaoFrom the Department of Biomedical Informatics, Harvard Medical School (J.A.D., P.R., L.M.-K., C.J.P., M.F., A.K.M.), the Computational Health Informatics Program, Boston Children's Hospital (J.A.D., A.K.M.), the Analytic and Translational Genetics Unit (Y.H., A.R.M.) and the Division of Pulmonary and Critical Care Medicine, Department of Medicine (M.F.), Massachusetts General Hospital, Harvard Internal Medicine-Pediatrics Combined Residency Program, Brigham and Women's Hospital, Boston Children's Hospital, and Boston Medical Center (R.K.), the François-Xavier Bagnoud Center for Health and Human Rights, Harvard University (R.K.), the Department of Medicine (M.J.N.T.) and the Channing Division of Network Medicine and the Division of Pulmonary and Critical Care Medicine, Department of Medicine (M.H.C., E.K.S.), Brigham and Women's Hospital, and the Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Beth Israel Deaconess Medical Center (S.L.), Boston, and the Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard, Cambridge (Y.H., A.R.M.) - all in Massachusetts; the Departments of Pediatrics (J.I.W.), Medicine (J.R.E., E.G.B.), and Bioengineering and Therapeutic Sciences (J.R.E., E.G.B.), University of California, San Francisco, San Francisco; the Department of Computer Science, Cornell University, Ithaca (E.P.), and the Department of Population Health Sciences, Weill Cornell Medical College (E.P.), and the Department of Epidemiology and Biostatistics, Graduate School of Public Health and Health Policy, City University of New York (L.N.B.), New York - all in New York; the Department of Engineering Science, University of Oxford, Oxford, United Kingdom (L.M.-K.); and the Medical Scientist Training Program, University of Illinois at Chicago, Chicago (A.Y.).ORCID 0000-0002-6134-4339
Yixuan HeFrom the Department of Biomedical Informatics, Harvard Medical School (J.A.D., P.R., L.M.-K., C.J.P., M.F., A.K.M.), the Computational Health Informatics Program, Boston Children's Hospital (J.A.D., A.K.M.), the Analytic and Translational Genetics Unit (Y.H., A.R.M.) and the Division of Pulmonary and Critical Care Medicine, Department of Medicine (M.F.), Massachusetts General Hospital, Harvard Internal Medicine-Pediatrics Combined Residency Program, Brigham and Women's Hospital, Boston Children's Hospital, and Boston Medical Center (R.K.), the François-Xavier Bagnoud Center for Health and Human Rights, Harvard University (R.K.), the Department of Medicine (M.J.N.T.) and the Channing Division of Network Medicine and the Division of Pulmonary and Critical Care Medicine, Department of Medicine (M.H.C., E.K.S.), Brigham and Women's Hospital, and the Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Beth Israel Deaconess Medical Center (S.L.), Boston, and the Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard, Cambridge (Y.H., A.R.M.) - all in Massachusetts; the Departments of Pediatrics (J.I.W.), Medicine (J.R.E., E.G.B.), and Bioengineering and Therapeutic Sciences (J.R.E., E.G.B.), University of California, San Francisco, San Francisco; the Department of Computer Science, Cornell University, Ithaca (E.P.), and the Department of Population Health Sciences, Weill Cornell Medical College (E.P.), and the Department of Epidemiology and Biostatistics, Graduate School of Public Health and Health Policy, City University of New York (L.N.B.), New York - all in New York; the Department of Engineering Science, University of Oxford, Oxford, United Kingdom (L.M.-K.); and the Medical Scientist Training Program, University of Illinois at Chicago, Chicago (A.Y.).
Rohan KhazanchiFrom the Department of Biomedical Informatics, Harvard Medical School (J.A.D., P.R., L.M.-K., C.J.P., M.F., A.K.M.), the Computational Health Informatics Program, Boston Children's Hospital (J.A.D., A.K.M.), the Analytic and Translational Genetics Unit (Y.H., A.R.M.) and the Division of Pulmonary and Critical Care Medicine, Department of Medicine (M.F.), Massachusetts General Hospital, Harvard Internal Medicine-Pediatrics Combined Residency Program, Brigham and Women's Hospital, Boston Children's Hospital, and Boston Medical Center (R.K.), the François-Xavier Bagnoud Center for Health and Human Rights, Harvard University (R.K.), the Department of Medicine (M.J.N.T.) and the Channing Division of Network Medicine and the Division of Pulmonary and Critical Care Medicine, Department of Medicine (M.H.C., E.K.S.), Brigham and Women's Hospital, and the Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Beth Israel Deaconess Medical Center (S.L.), Boston, and the Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard, Cambridge (Y.H., A.R.M.) - all in Massachusetts; the Departments of Pediatrics (J.I.W.), Medicine (J.R.E., E.G.B.), and Bioengineering and Therapeutic Sciences (J.R.E., E.G.B.), University of California, San Francisco, San Francisco; the Department of Computer Science, Cornell University, Ithaca (E.P.), and the Department of Population Health Sciences, Weill Cornell Medical College (E.P.), and the Department of Epidemiology and Biostatistics, Graduate School of Public Health and Health Policy, City University of New York (L.N.B.), New York - all in New York; the Department of Engineering Science, University of Oxford, Oxford, United Kingdom (L.M.-K.); and the Medical Scientist Training Program, University of Illinois at Chicago, Chicago (A.Y.).
Max Jordan Nguemeni TiakoFrom the Department of Biomedical Informatics, Harvard Medical School (J.A.D., P.R., L.M.-K., C.J.P., M.F., A.K.M.), the Computational Health Informatics Program, Boston Children's Hospital (J.A.D., A.K.M.), the Analytic and Translational Genetics Unit (Y.H., A.R.M.) and the Division of Pulmonary and Critical Care Medicine, Department of Medicine (M.F.), Massachusetts General Hospital, Harvard Internal Medicine-Pediatrics Combined Residency Program, Brigham and Women's Hospital, Boston Children's Hospital, and Boston Medical Center (R.K.), the François-Xavier Bagnoud Center for Health and Human Rights, Harvard University (R.K.), the Department of Medicine (M.J.N.T.) and the Channing Division of Network Medicine and the Division of Pulmonary and Critical Care Medicine, Department of Medicine (M.H.C., E.K.S.), Brigham and Women's Hospital, and the Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Beth Israel Deaconess Medical Center (S.L.), Boston, and the Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard, Cambridge (Y.H., A.R.M.) - all in Massachusetts; the Departments of Pediatrics (J.I.W.), Medicine (J.R.E., E.G.B.), and Bioengineering and Therapeutic Sciences (J.R.E., E.G.B.), University of California, San Francisco, San Francisco; the Department of Computer Science, Cornell University, Ithaca (E.P.), and the Department of Population Health Sciences, Weill Cornell Medical College (E.P.), and the Department of Epidemiology and Biostatistics, Graduate School of Public Health and Health Policy, City University of New York (L.N.B.), New York - all in New York; the Department of Engineering Science, University of Oxford, Oxford, United Kingdom (L.M.-K.); and the Medical Scientist Training Program, University of Illinois at Chicago, Chicago (A.Y.).
Jonathan I WitonskyFrom the Department of Biomedical Informatics, Harvard Medical School (J.A.D., P.R., L.M.-K., C.J.P., M.F., A.K.M.), the Computational Health Informatics Program, Boston Children's Hospital (J.A.D., A.K.M.), the Analytic and Translational Genetics Unit (Y.H., A.R.M.) and the Division of Pulmonary and Critical Care Medicine, Department of Medicine (M.F.), Massachusetts General Hospital, Harvard Internal Medicine-Pediatrics Combined Residency Program, Brigham and Women's Hospital, Boston Children's Hospital, and Boston Medical Center (R.K.), the François-Xavier Bagnoud Center for Health and Human Rights, Harvard University (R.K.), the Department of Medicine (M.J.N.T.) and the Channing Division of Network Medicine and the Division of Pulmonary and Critical Care Medicine, Department of Medicine (M.H.C., E.K.S.), Brigham and Women's Hospital, and the Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Beth Israel Deaconess Medical Center (S.L.), Boston, and the Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard, Cambridge (Y.H., A.R.M.) - all in Massachusetts; the Departments of Pediatrics (J.I.W.), Medicine (J.R.E., E.G.B.), and Bioengineering and Therapeutic Sciences (J.R.E., E.G.B.), University of California, San Francisco, San Francisco; the Department of Computer Science, Cornell University, Ithaca (E.P.), and the Department of Population Health Sciences, Weill Cornell Medical College (E.P.), and the Department of Epidemiology and Biostatistics, Graduate School of Public Health and Health Policy, City University of New York (L.N.B.), New York - all in New York; the Department of Engineering Science, University of Oxford, Oxford, United Kingdom (L.M.-K.); and the Medical Scientist Training Program, University of Illinois at Chicago, Chicago (A.Y.).
Emma PiersonFrom the Department of Biomedical Informatics, Harvard Medical School (J.A.D., P.R., L.M.-K., C.J.P., M.F., A.K.M.), the Computational Health Informatics Program, Boston Children's Hospital (J.A.D., A.K.M.), the Analytic and Translational Genetics Unit (Y.H., A.R.M.) and the Division of Pulmonary and Critical Care Medicine, Department of Medicine (M.F.), Massachusetts General Hospital, Harvard Internal Medicine-Pediatrics Combined Residency Program, Brigham and Women's Hospital, Boston Children's Hospital, and Boston Medical Center (R.K.), the François-Xavier Bagnoud Center for Health and Human Rights, Harvard University (R.K.), the Department of Medicine (M.J.N.T.) and the Channing Division of Network Medicine and the Division of Pulmonary and Critical Care Medicine, Department of Medicine (M.H.C., E.K.S.), Brigham and Women's Hospital, and the Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Beth Israel Deaconess Medical Center (S.L.), Boston, and the Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard, Cambridge (Y.H., A.R.M.) - all in Massachusetts; the Departments of Pediatrics (J.I.W.), Medicine (J.R.E., E.G.B.), and Bioengineering and Therapeutic Sciences (J.R.E., E.G.B.), University of California, San Francisco, San Francisco; the Department of Computer Science, Cornell University, Ithaca (E.P.), and the Department of Population Health Sciences, Weill Cornell Medical College (E.P.), and the Department of Epidemiology and Biostatistics, Graduate School of Public Health and Health Policy, City University of New York (L.N.B.), New York - all in New York; the Department of Engineering Science, University of Oxford, Oxford, United Kingdom (L.M.-K.); and the Medical Scientist Training Program, University of Illinois at Chicago, Chicago (A.Y.).
Pranav RajpurkarFrom the Department of Biomedical Informatics, Harvard Medical School (J.A.D., P.R., L.M.-K., C.J.P., M.F., A.K.M.), the Computational Health Informatics Program, Boston Children's Hospital (J.A.D., A.K.M.), the Analytic and Translational Genetics Unit (Y.H., A.R.M.) and the Division of Pulmonary and Critical Care Medicine, Department of Medicine (M.F.), Massachusetts General Hospital, Harvard Internal Medicine-Pediatrics Combined Residency Program, Brigham and Women's Hospital, Boston Children's Hospital, and Boston Medical Center (R.K.), the François-Xavier Bagnoud Center for Health and Human Rights, Harvard University (R.K.), the Department of Medicine (M.J.N.T.) and the Channing Division of Network Medicine and the Division of Pulmonary and Critical Care Medicine, Department of Medicine (M.H.C., E.K.S.), Brigham and Women's Hospital, and the Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Beth Israel Deaconess Medical Center (S.L.), Boston, and the Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard, Cambridge (Y.H., A.R.M.) - all in Massachusetts; the Departments of Pediatrics (J.I.W.), Medicine (J.R.E., E.G.B.), and Bioengineering and Therapeutic Sciences (J.R.E., E.G.B.), University of California, San Francisco, San Francisco; the Department of Computer Science, Cornell University, Ithaca (E.P.), and the Department of Population Health Sciences, Weill Cornell Medical College (E.P.), and the Department of Epidemiology and Biostatistics, Graduate School of Public Health and Health Policy, City University of New York (L.N.B.), New York - all in New York; the Department of Engineering Science, University of Oxford, Oxford, United Kingdom (L.M.-K.); and the Medical Scientist Training Program, University of Illinois at Chicago, Chicago (A.Y.).ORCID 0000-0002-8030-3727
Jennifer R ElhawaryFrom the Department of Biomedical Informatics, Harvard Medical School (J.A.D., P.R., L.M.-K., C.J.P., M.F., A.K.M.), the Computational Health Informatics Program, Boston Children's Hospital (J.A.D., A.K.M.), the Analytic and Translational Genetics Unit (Y.H., A.R.M.) and the Division of Pulmonary and Critical Care Medicine, Department of Medicine (M.F.), Massachusetts General Hospital, Harvard Internal Medicine-Pediatrics Combined Residency Program, Brigham and Women's Hospital, Boston Children's Hospital, and Boston Medical Center (R.K.), the François-Xavier Bagnoud Center for Health and Human Rights, Harvard University (R.K.), the Department of Medicine (M.J.N.T.) and the Channing Division of Network Medicine and the Division of Pulmonary and Critical Care Medicine, Department of Medicine (M.H.C., E.K.S.), Brigham and Women's Hospital, and the Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Beth Israel Deaconess Medical Center (S.L.), Boston, and the Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard, Cambridge (Y.H., A.R.M.) - all in Massachusetts; the Departments of Pediatrics (J.I.W.), Medicine (J.R.E., E.G.B.), and Bioengineering and Therapeutic Sciences (J.R.E., E.G.B.), University of California, San Francisco, San Francisco; the Department of Computer Science, Cornell University, Ithaca (E.P.), and the Department of Population Health Sciences, Weill Cornell Medical College (E.P.), and the Department of Epidemiology and Biostatistics, Graduate School of Public Health and Health Policy, City University of New York (L.N.B.), New York - all in New York; the Department of Engineering Science, University of Oxford, Oxford, United Kingdom (L.M.-K.); and the Medical Scientist Training Program, University of Illinois at Chicago, Chicago (A.Y.).ORCID 0000-0003-3326-1680
Luke Melas-KyriaziFrom the Department of Biomedical Informatics, Harvard Medical School (J.A.D., P.R., L.M.-K., C.J.P., M.F., A.K.M.), the Computational Health Informatics Program, Boston Children's Hospital (J.A.D., A.K.M.), the Analytic and Translational Genetics Unit (Y.H., A.R.M.) and the Division of Pulmonary and Critical Care Medicine, Department of Medicine (M.F.), Massachusetts General Hospital, Harvard Internal Medicine-Pediatrics Combined Residency Program, Brigham and Women's Hospital, Boston Children's Hospital, and Boston Medical Center (R.K.), the François-Xavier Bagnoud Center for Health and Human Rights, Harvard University (R.K.), the Department of Medicine (M.J.N.T.) and the Channing Division of Network Medicine and the Division of Pulmonary and Critical Care Medicine, Department of Medicine (M.H.C., E.K.S.), Brigham and Women's Hospital, and the Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Beth Israel Deaconess Medical Center (S.L.), Boston, and the Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard, Cambridge (Y.H., A.R.M.) - all in Massachusetts; the Departments of Pediatrics (J.I.W.), Medicine (J.R.E., E.G.B.), and Bioengineering and Therapeutic Sciences (J.R.E., E.G.B.), University of California, San Francisco, San Francisco; the Department of Computer Science, Cornell University, Ithaca (E.P.), and the Department of Population Health Sciences, Weill Cornell Medical College (E.P.), and the Department of Epidemiology and Biostatistics, Graduate School of Public Health and Health Policy, City University of New York (L.N.B.), New York - all in New York; the Department of Engineering Science, University of Oxford, Oxford, United Kingdom (L.M.-K.); and the Medical Scientist Training Program, University of Illinois at Chicago, Chicago (A.Y.).
Albert YenFrom the Department of Biomedical Informatics, Harvard Medical School (J.A.D., P.R., L.M.-K., C.J.P., M.F., A.K.M.), the Computational Health Informatics Program, Boston Children's Hospital (J.A.D., A.K.M.), the Analytic and Translational Genetics Unit (Y.H., A.R.M.) and the Division of Pulmonary and Critical Care Medicine, Department of Medicine (M.F.), Massachusetts General Hospital, Harvard Internal Medicine-Pediatrics Combined Residency Program, Brigham and Women's Hospital, Boston Children's Hospital, and Boston Medical Center (R.K.), the François-Xavier Bagnoud Center for Health and Human Rights, Harvard University (R.K.), the Department of Medicine (M.J.N.T.) and the Channing Division of Network Medicine and the Division of Pulmonary and Critical Care Medicine, Department of Medicine (M.H.C., E.K.S.), Brigham and Women's Hospital, and the Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Beth Israel Deaconess Medical Center (S.L.), Boston, and the Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard, Cambridge (Y.H., A.R.M.) - all in Massachusetts; the Departments of Pediatrics (J.I.W.), Medicine (J.R.E., E.G.B.), and Bioengineering and Therapeutic Sciences (J.R.E., E.G.B.), University of California, San Francisco, San Francisco; the Department of Computer Science, Cornell University, Ithaca (E.P.), and the Department of Population Health Sciences, Weill Cornell Medical College (E.P.), and the Department of Epidemiology and Biostatistics, Graduate School of Public Health and Health Policy, City University of New York (L.N.B.), New York - all in New York; the Department of Engineering Science, University of Oxford, Oxford, United Kingdom (L.M.-K.); and the Medical Scientist Training Program, University of Illinois at Chicago, Chicago (A.Y.).
Alicia R MartinFrom the Department of Biomedical Informatics, Harvard Medical School (J.A.D., P.R., L.M.-K., C.J.P., M.F., A.K.M.), the Computational Health Informatics Program, Boston Children's Hospital (J.A.D., A.K.M.), the Analytic and Translational Genetics Unit (Y.H., A.R.M.) and the Division of Pulmonary and Critical Care Medicine, Department of Medicine (M.F.), Massachusetts General Hospital, Harvard Internal Medicine-Pediatrics Combined Residency Program, Brigham and Women's Hospital, Boston Children's Hospital, and Boston Medical Center (R.K.), the François-Xavier Bagnoud Center for Health and Human Rights, Harvard University (R.K.), the Department of Medicine (M.J.N.T.) and the Channing Division of Network Medicine and the Division of Pulmonary and Critical Care Medicine, Department of Medicine (M.H.C., E.K.S.), Brigham and Women's Hospital, and the Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Beth Israel Deaconess Medical Center (S.L.), Boston, and the Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard, Cambridge (Y.H., A.R.M.) - all in Massachusetts; the Departments of Pediatrics (J.I.W.), Medicine (J.R.E., E.G.B.), and Bioengineering and Therapeutic Sciences (J.R.E., E.G.B.), University of California, San Francisco, San Francisco; the Department of Computer Science, Cornell University, Ithaca (E.P.), and the Department of Population Health Sciences, Weill Cornell Medical College (E.P.), and the Department of Epidemiology and Biostatistics, Graduate School of Public Health and Health Policy, City University of New York (L.N.B.), New York - all in New York; the Department of Engineering Science, University of Oxford, Oxford, United Kingdom (L.M.-K.); and the Medical Scientist Training Program, University of Illinois at Chicago, Chicago (A.Y.).
Sean LevyFrom the Department of Biomedical Informatics, Harvard Medical School (J.A.D., P.R., L.M.-K., C.J.P., M.F., A.K.M.), the Computational Health Informatics Program, Boston Children's Hospital (J.A.D., A.K.M.), the Analytic and Translational Genetics Unit (Y.H., A.R.M.) and the Division of Pulmonary and Critical Care Medicine, Department of Medicine (M.F.), Massachusetts General Hospital, Harvard Internal Medicine-Pediatrics Combined Residency Program, Brigham and Women's Hospital, Boston Children's Hospital, and Boston Medical Center (R.K.), the François-Xavier Bagnoud Center for Health and Human Rights, Harvard University (R.K.), the Department of Medicine (M.J.N.T.) and the Channing Division of Network Medicine and the Division of Pulmonary and Critical Care Medicine, Department of Medicine (M.H.C., E.K.S.), Brigham and Women's Hospital, and the Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Beth Israel Deaconess Medical Center (S.L.), Boston, and the Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard, Cambridge (Y.H., A.R.M.) - all in Massachusetts; the Departments of Pediatrics (J.I.W.), Medicine (J.R.E., E.G.B.), and Bioengineering and Therapeutic Sciences (J.R.E., E.G.B.), University of California, San Francisco, San Francisco; the Department of Computer Science, Cornell University, Ithaca (E.P.), and the Department of Population Health Sciences, Weill Cornell Medical College (E.P.), and the Department of Epidemiology and Biostatistics, Graduate School of Public Health and Health Policy, City University of New York (L.N.B.), New York - all in New York; the Department of Engineering Science, University of Oxford, Oxford, United Kingdom (L.M.-K.); and the Medical Scientist Training Program, University of Illinois at Chicago, Chicago (A.Y.).
Chirag J PatelFrom the Department of Biomedical Informatics, Harvard Medical School (J.A.D., P.R., L.M.-K., C.J.P., M.F., A.K.M.), the Computational Health Informatics Program, Boston Children's Hospital (J.A.D., A.K.M.), the Analytic and Translational Genetics Unit (Y.H., A.R.M.) and the Division of Pulmonary and Critical Care Medicine, Department of Medicine (M.F.), Massachusetts General Hospital, Harvard Internal Medicine-Pediatrics Combined Residency Program, Brigham and Women's Hospital, Boston Children's Hospital, and Boston Medical Center (R.K.), the François-Xavier Bagnoud Center for Health and Human Rights, Harvard University (R.K.), the Department of Medicine (M.J.N.T.) and the Channing Division of Network Medicine and the Division of Pulmonary and Critical Care Medicine, Department of Medicine (M.H.C., E.K.S.), Brigham and Women's Hospital, and the Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Beth Israel Deaconess Medical Center (S.L.), Boston, and the Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard, Cambridge (Y.H., A.R.M.) - all in Massachusetts; the Departments of Pediatrics (J.I.W.), Medicine (J.R.E., E.G.B.), and Bioengineering and Therapeutic Sciences (J.R.E., E.G.B.), University of California, San Francisco, San Francisco; the Department of Computer Science, Cornell University, Ithaca (E.P.), and the Department of Population Health Sciences, Weill Cornell Medical College (E.P.), and the Department of Epidemiology and Biostatistics, Graduate School of Public Health and Health Policy, City University of New York (L.N.B.), New York - all in New York; the Department of Engineering Science, University of Oxford, Oxford, United Kingdom (L.M.-K.); and the Medical Scientist Training Program, University of Illinois at Chicago, Chicago (A.Y.).
Maha FarhatFrom the Department of Biomedical Informatics, Harvard Medical School (J.A.D., P.R., L.M.-K., C.J.P., M.F., A.K.M.), the Computational Health Informatics Program, Boston Children's Hospital (J.A.D., A.K.M.), the Analytic and Translational Genetics Unit (Y.H., A.R.M.) and the Division of Pulmonary and Critical Care Medicine, Department of Medicine (M.F.), Massachusetts General Hospital, Harvard Internal Medicine-Pediatrics Combined Residency Program, Brigham and Women's Hospital, Boston Children's Hospital, and Boston Medical Center (R.K.), the François-Xavier Bagnoud Center for Health and Human Rights, Harvard University (R.K.), the Department of Medicine (M.J.N.T.) and the Channing Division of Network Medicine and the Division of Pulmonary and Critical Care Medicine, Department of Medicine (M.H.C., E.K.S.), Brigham and Women's Hospital, and the Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Beth Israel Deaconess Medical Center (S.L.), Boston, and the Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard, Cambridge (Y.H., A.R.M.) - all in Massachusetts; the Departments of Pediatrics (J.I.W.), Medicine (J.R.E., E.G.B.), and Bioengineering and Therapeutic Sciences (J.R.E., E.G.B.), University of California, San Francisco, San Francisco; the Department of Computer Science, Cornell University, Ithaca (E.P.), and the Department of Population Health Sciences, Weill Cornell Medical College (E.P.), and the Department of Epidemiology and Biostatistics, Graduate School of Public Health and Health Policy, City University of New York (L.N.B.), New York - all in New York; the Department of Engineering Science, University of Oxford, Oxford, United Kingdom (L.M.-K.); and the Medical Scientist Training Program, University of Illinois at Chicago, Chicago (A.Y.).
Luisa N BorrellFrom the Department of Biomedical Informatics, Harvard Medical School (J.A.D., P.R., L.M.-K., C.J.P., M.F., A.K.M.), the Computational Health Informatics Program, Boston Children's Hospital (J.A.D., A.K.M.), the Analytic and Translational Genetics Unit (Y.H., A.R.M.) and the Division of Pulmonary and Critical Care Medicine, Department of Medicine (M.F.), Massachusetts General Hospital, Harvard Internal Medicine-Pediatrics Combined Residency Program, Brigham and Women's Hospital, Boston Children's Hospital, and Boston Medical Center (R.K.), the François-Xavier Bagnoud Center for Health and Human Rights, Harvard University (R.K.), the Department of Medicine (M.J.N.T.) and the Channing Division of Network Medicine and the Division of Pulmonary and Critical Care Medicine, Department of Medicine (M.H.C., E.K.S.), Brigham and Women's Hospital, and the Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Beth Israel Deaconess Medical Center (S.L.), Boston, and the Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard, Cambridge (Y.H., A.R.M.) - all in Massachusetts; the Departments of Pediatrics (J.I.W.), Medicine (J.R.E., E.G.B.), and Bioengineering and Therapeutic Sciences (J.R.E., E.G.B.), University of California, San Francisco, San Francisco; the Department of Computer Science, Cornell University, Ithaca (E.P.), and the Department of Population Health Sciences, Weill Cornell Medical College (E.P.), and the Department of Epidemiology and Biostatistics, Graduate School of Public Health and Health Policy, City University of New York (L.N.B.), New York - all in New York; the Department of Engineering Science, University of Oxford, Oxford, United Kingdom (L.M.-K.); and the Medical Scientist Training Program, University of Illinois at Chicago, Chicago (A.Y.).
Michael H ChoFrom the Department of Biomedical Informatics, Harvard Medical School (J.A.D., P.R., L.M.-K., C.J.P., M.F., A.K.M.), the Computational Health Informatics Program, Boston Children's Hospital (J.A.D., A.K.M.), the Analytic and Translational Genetics Unit (Y.H., A.R.M.) and the Division of Pulmonary and Critical Care Medicine, Department of Medicine (M.F.), Massachusetts General Hospital, Harvard Internal Medicine-Pediatrics Combined Residency Program, Brigham and Women's Hospital, Boston Children's Hospital, and Boston Medical Center (R.K.), the François-Xavier Bagnoud Center for Health and Human Rights, Harvard University (R.K.), the Department of Medicine (M.J.N.T.) and the Channing Division of Network Medicine and the Division of Pulmonary and Critical Care Medicine, Department of Medicine (M.H.C., E.K.S.), Brigham and Women's Hospital, and the Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Beth Israel Deaconess Medical Center (S.L.), Boston, and the Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard, Cambridge (Y.H., A.R.M.) - all in Massachusetts; the Departments of Pediatrics (J.I.W.), Medicine (J.R.E., E.G.B.), and Bioengineering and Therapeutic Sciences (J.R.E., E.G.B.), University of California, San Francisco, San Francisco; the Department of Computer Science, Cornell University, Ithaca (E.P.), and the Department of Population Health Sciences, Weill Cornell Medical College (E.P.), and the Department of Epidemiology and Biostatistics, Graduate School of Public Health and Health Policy, City University of New York (L.N.B.), New York - all in New York; the Department of Engineering Science, University of Oxford, Oxford, United Kingdom (L.M.-K.); and the Medical Scientist Training Program, University of Illinois at Chicago, Chicago (A.Y.).
Edwin K SilvermanFrom the Department of Biomedical Informatics, Harvard Medical School (J.A.D., P.R., L.M.-K., C.J.P., M.F., A.K.M.), the Computational Health Informatics Program, Boston Children's Hospital (J.A.D., A.K.M.), the Analytic and Translational Genetics Unit (Y.H., A.R.M.) and the Division of Pulmonary and Critical Care Medicine, Department of Medicine (M.F.), Massachusetts General Hospital, Harvard Internal Medicine-Pediatrics Combined Residency Program, Brigham and Women's Hospital, Boston Children's Hospital, and Boston Medical Center (R.K.), the François-Xavier Bagnoud Center for Health and Human Rights, Harvard University (R.K.), the Department of Medicine (M.J.N.T.) and the Channing Division of Network Medicine and the Division of Pulmonary and Critical Care Medicine, Department of Medicine (M.H.C., E.K.S.), Brigham and Women's Hospital, and the Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Beth Israel Deaconess Medical Center (S.L.), Boston, and the Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard, Cambridge (Y.H., A.R.M.) - all in Massachusetts; the Departments of Pediatrics (J.I.W.), Medicine (J.R.E., E.G.B.), and Bioengineering and Therapeutic Sciences (J.R.E., E.G.B.), University of California, San Francisco, San Francisco; the Department of Computer Science, Cornell University, Ithaca (E.P.), and the Department of Population Health Sciences, Weill Cornell Medical College (E.P.), and the Department of Epidemiology and Biostatistics, Graduate School of Public Health and Health Policy, City University of New York (L.N.B.), New York - all in New York; the Department of Engineering Science, University of Oxford, Oxford, United Kingdom (L.M.-K.); and the Medical Scientist Training Program, University of Illinois at Chicago, Chicago (A.Y.).
Esteban G BurchardFrom the Department of Biomedical Informatics, Harvard Medical School (J.A.D., P.R., L.M.-K., C.J.P., M.F., A.K.M.), the Computational Health Informatics Program, Boston Children's Hospital (J.A.D., A.K.M.), the Analytic and Translational Genetics Unit (Y.H., A.R.M.) and the Division of Pulmonary and Critical Care Medicine, Department of Medicine (M.F.), Massachusetts General Hospital, Harvard Internal Medicine-Pediatrics Combined Residency Program, Brigham and Women's Hospital, Boston Children's Hospital, and Boston Medical Center (R.K.), the François-Xavier Bagnoud Center for Health and Human Rights, Harvard University (R.K.), the Department of Medicine (M.J.N.T.) and the Channing Division of Network Medicine and the Division of Pulmonary and Critical Care Medicine, Department of Medicine (M.H.C., E.K.S.), Brigham and Women's Hospital, and the Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Beth Israel Deaconess Medical Center (S.L.), Boston, and the Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard, Cambridge (Y.H., A.R.M.) - all in Massachusetts; the Departments of Pediatrics (J.I.W.), Medicine (J.R.E., E.G.B.), and Bioengineering and Therapeutic Sciences (J.R.E., E.G.B.), University of California, San Francisco, San Francisco; the Department of Computer Science, Cornell University, Ithaca (E.P.), and the Department of Population Health Sciences, Weill Cornell Medical College (E.P.), and the Department of Epidemiology and Biostatistics, Graduate School of Public Health and Health Policy, City University of New York (L.N.B.), New York - all in New York; the Department of Engineering Science, University of Oxford, Oxford, United Kingdom (L.M.-K.); and the Medical Scientist Training Program, University of Illinois at Chicago, Chicago (A.Y.).
Arjun K ManraiFrom the Department of Biomedical Informatics, Harvard Medical School (J.A.D., P.R., L.M.-K., C.J.P., M.F., A.K.M.), the Computational Health Informatics Program, Boston Children's Hospital (J.A.D., A.K.M.), the Analytic and Translational Genetics Unit (Y.H., A.R.M.) and the Division of Pulmonary and Critical Care Medicine, Department of Medicine (M.F.), Massachusetts General Hospital, Harvard Internal Medicine-Pediatrics Combined Residency Program, Brigham and Women's Hospital, Boston Children's Hospital, and Boston Medical Center (R.K.), the François-Xavier Bagnoud Center for Health and Human Rights, Harvard University (R.K.), the Department of Medicine (M.J.N.T.) and the Channing Division of Network Medicine and the Division of Pulmonary and Critical Care Medicine, Department of Medicine (M.H.C., E.K.S.), Brigham and Women's Hospital, and the Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Beth Israel Deaconess Medical Center (S.L.), Boston, and the Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard, Cambridge (Y.H., A.R.M.) - all in Massachusetts; the Departments of Pediatrics (J.I.W.), Medicine (J.R.E., E.G.B.), and Bioengineering and Therapeutic Sciences (J.R.E., E.G.B.), University of California, San Francisco, San Francisco; the Department of Computer Science, Cornell University, Ithaca (E.P.), and the Department of Population Health Sciences, Weill Cornell Medical College (E.P.), and the Department of Epidemiology and Biostatistics, Graduate School of Public Health and Health Policy, City University of New York (L.N.B.), New York - all in New York; the Department of Engineering Science, University of Oxford, Oxford, United Kingdom (L.M.-K.); and the Medical Scientist Training Program, University of Illinois at Chicago, Chicago (A.Y.).ORCID 0000-0001-9657-9800

Funding

Training Program in Bioinformatics and Integrative GenomicsT32HG002295 · NHGRI · MASSACHUSETTS INSTITUTE OF TECHNOLOGY · PI Peter J Park · 2001 to 2026
$15.8M
NRSA Training CoreTL1TR001871 · NCATS · UNIVERSITY OF CALIFORNIA, SAN FRANCISCO · PI KANAYA, ALKA M., SOMSOUK, MA · 2016 to 2025
$10.1M
Data science tools to identify robust exposure-phenotype associations for precision medicineR01ES032470 · NIEHS · HARVARD MEDICAL SCHOOL · PI MANRAI, ARJUN KUMAR, PATEL, CHIRAG J. · 2021 to 2025
$3.5M
Precision Cardiovascular Medicine for Multi-Ethnic PopulationsK01HL138259 · NHLBI · HARVARD MEDICAL SCHOOL · PI MANRAI, ARJUN KUMAR · 2018 to 2022
$801k
Improving Prediction of Asthma-related Outcomes with Genetic Ancestry-informed Lung Function EquationsK23HL169911 · NHLBI · UNIVERSITY OF CALIFORNIA, SAN FRANCISCO · PI Jonathan Witonsky · 2023 to 2026
$688k
NCATS NIH HHS TL1 TR001871NHGRI NIH HHS T32 HG002295NHLBI NIH HHS K01 HL138259NHLBI NIH HHS K01HL138259NHLBI NIH HHS K23 HL169911NIEHS NIH HHS R01 ES032470NIEHS NIH HHS R01ES032470
6 · The paper itself

Abstract

backgroundAdjustment for race is discouraged in lung-function testing, but the implications of adopting race-neutral equations have not been comprehensively quantified.

methodsWe obtained longitudinal data from 369,077 participants in the National Health and Nutrition Examination Survey, U.K. Biobank, the Multi-Ethnic Study of Atherosclerosis, and the Organ Procurement and Transplantation Network. Using these data, we compared the race-based 2012 Global Lung Function Initiative (GLI-2012) equations with race-neutral equations introduced in 2022 (GLI-Global). Evaluated outcomes included national projections of clinical, occupational, and financial reclassifications; individual lung-allocation scores for transplantation priority; and concordance statistics (C statistics) for clinical prediction tasks.

resultsAmong the 249 million persons in the United States between 6 and 79 years of age who are able to produce high-quality spirometric results, the use of GLI-Global equations may reclassify ventilatory impairment for 12.5 million persons, medical impairment ratings for 8.16 million, occupational eligibility for 2.28 million, grading of chronic obstructive pulmonary disease for 2.05 million, and military disability compensation for 413,000. These potential changes differed according to race; for example, classifications of nonobstructive ventilatory impairment may change dramatically, increasing 141% (95% confidence interval [CI], 113 to 169) among Black persons and decreasing 69% (95% CI, 63 to 74) among White persons. Annual disability payments may increase by more than $1 billion among Black veterans and decrease by $0.5 billion among White veterans. GLI-2012 and GLI-Global equations had similar discriminative accuracy with regard to respiratory symptoms, health care utilization, new-onset disease, death from any cause, death related to respiratory disease, and death among persons on a transplant waiting list, with differences in C statistics ranging from -0.008 to 0.011.

conclusionsThe use of race-based and race-neutral equations generated similarly accurate predictions of respiratory outcomes but assigned different disease classifications, occupational eligibility, and disability compensation for millions of persons, with effects diverging according to race. (Funded by the National Heart Lung and Blood Institute and the National Institute of Environmental Health Sciences.).

Indexed as

Respiratory Function TestsRespiratory InsufficiencyAdolescentAdultAgedBlack or African AmericanChildDisability EvaluationFemaleFinancing, GovernmentHumansLung DiseasesLung TransplantationMaleMiddle AgedNutrition Surveys

Identifiers

PMID38767252
PMCPMC11305821

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.