Moitra S, Mitra R, Moitra S. Comparison of race-specific and race-neutral GLI spirometric reference equations with an Indian reference equation.
Respir Med 2024;
232:107764. [PMID:
39134159 DOI:
10.1016/j.rmed.2024.107764]
[Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2024] [Revised: 07/29/2024] [Accepted: 08/08/2024] [Indexed: 08/16/2024]
Abstract
BACKGROUND
Despite the increasing popularity and use of Global Lung Function Initiative (GLI) spirometric reference equations, the appropriateness of the race-specific and race-neutral GLI spirometric reference models among the Indian population has not been systematically investigated.
METHODS
In this cross-sectional analysis, we used spirometric measurements of 1123 healthy Indian adults (≥18 years of age). We computed reference values and z-scores for forced vital capacity (FVC), forced expiratory volume in 1 s (FEV1), and FEV1/FVC from race-specific and race-neutral GLI reference equations as well as from a widely used Indian reference equation. We studied heterogeneity between GLI equations and the Indian equations using Bland-Altman analysis, and the differences between the reference and observed values were compared using the Friedman test.
RESULTS
In Bland-Altman analysis, significant heterogeneity in FVC and FEV1 between race-specific and Indian equations was observed (bias: 10.4 % and 14.1 %, respectively), with less bias for FEV1/FVC (3.76 %). The race-neutral equations showed almost similar bias (9.8 %, 13.8 %, and 3.8 % for FVC, FEV1, and FEV1/FVC, respectively). Median differences in race-specific reference values from observed values for FVC and FEV1 were 0.49L and 0.44L, respectively, decreasing slightly with race-neutral equations (0.46L and 0.43L) whereas Indian models showed minimal differences (FVC: 0.10L, FEV1: 0.05L). Z-scores for FVC and FEV1 were significantly different between race-specific and race-neutral GLI equations, and both differed from Indian equations.
CONCLUSION
Both race-specific and race-neutral GLI reference equations are significantly different from the Indian equations, which underscores the importance of determining the suitability of global reference models before being used indiscriminately.
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