End the Use of Race Adjustment Factor in Pulmonary Function Testing, Authors Say

Continuing the race adjustment factors maintains health care disparities, the authors noted.

Clinicians should stop using the race adjustment factor in pulmonary function testing (PFT), according to a recent entry in the Things We Do for No Reason series in the Journal of Hospital Medicine.

The authors wrote that adjusting spirometry values stems from old studies about differences in lung function among races, which were then applied to testing. As a result, lung volume reference values for Black patients are 10% to 15% lower than values for White patients.

There are 3 reasons why the race adjustment factor in PFT is injurious to patients, the authors wrote:

  • Accepting the race factor ignores genetic and social determinants of health (SDOH) as factors in disease and poor health
  • Underdiagnosis of pulmonary disease hinders access to treatment and lengthens time to diagnosis, both of which have an impact on outcomes
  • Race is a social construct and does not accurately reflect a diverse or multiracial background nor does it account for genetic and geographic differences

“The medical community should follow the lead of other equations, like estimated glomerular filtration rate and the vaginal birth after cesarean calculator, which have successfully removed race factors,” the authors wrote.

Continuing race adjustment maintains health care disparities, they said, and any concerns about the possibility of overdiagnosing disease must be outweighed by the harm that comes from underdiagnosing it.

They called upon clinicians to:

  • Stop using the race factor in calculating PFTs and enter every patient as “White" to apply a race factor of 1 if forced to use a spirometer with a race factor
  • Tell patients whenever a race factor is used
  • Push for the development and manufacturing of spirometers without race factors
  • Advocate for further research into the relationship between lung capacity and SDOH factors
  • Ask patients about their SDOH factors as part of an individualized approach to care for lung disease

“As a profession, we must practice race-conscious medicine that values individualized care, recognizes the contributions of structural racism and social determinants in patient health, and standardize care when possible, based on objective metrics,” they wrote.

The Things We Do for No Reason series is inspired by the Choosing Wisely program, which seeks to promote high-value care by educating clinicians and the public about low-value care.


Beaverson S, Ngo VM, Pahuja M, Dow A, Nana-Sinkham P, Schefft M. Things We Do for No Reason: race adjustments in calculating lung function from spirometry measurements. J Hosp Med. Published online October 7, 2022. 10.1002/jhm.12974

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