本文由小咖机器人翻译整理

期刊来源：N Engl J Med

原文链接：https://doi.org/10.1056/NEJMsa2311809

摘要内容如下：

背景

在肺功能测试中不鼓励对种族进行调整，但采用种族中性方程的影响尚未得到全面量化。

方法

我们获得了369，077名参与者的纵向数据，这些参与者来自国家健康和营养调查、英国生物库、动脉粥样硬化多种族研究以及器官获取和移植网络。利用这些数据，我们比较了基于种族的2012年全球肺功能倡议（GLI-2012）方程和2022年引入的种族中性方程（GLI-Global）。评估结果包括临床、职业和财务重新分类的国家预测；移植优先的个体肺分配评分；以及用于临床预测任务的一致性统计（C统计）。

结果

在美国6-79岁之间的2.49亿人中，能够产生高质量的肺活量测定结果，使用Gli-Global方程可以对1250万人的通气损伤进行重新分类，对816万人进行医学损伤评级，对228万人进行职业资格评级，对205万人进行慢性阻塞性肺病评级，对413，000人进行军事伤残赔偿。这些潜在的变化因种族而异；例如，非阻塞性通气障碍的分类可能发生显著变化，黑人增加141%（95%置信区间[CI]，113至169），白人减少69%（95%CI，63至74）。黑人退伍军人的年度残疾补助可能增加10亿美元以上，而白人退伍军人的年度残疾补助可能减少5亿美元。GLI-2012和GLI-Global方程在呼吸系统症状、卫生保健利用、新发疾病、任何原因导致的死亡、与呼吸系统疾病相关的死亡以及移植等待名单上的人的死亡方面具有相似的判别准确性，C统计量的差异范围为-0.008至0.011。

结论

基于种族和种族中性方程的使用对呼吸结果产生了类似的准确预测，但为数百万人分配了不同的疾病分类、职业资格和残疾补偿，其影响因种族而异。（由国家心肺血液研究所和国家环境健康科学研究所资助）。

英文原文如下：

Abstracts

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

METHODS  We 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.

RESULTS  Among 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.

CONCLUSIONS  The 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.).

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