Harber, Philip

Abstract RATIONALE: The American Thoracic Society (ATS) recently recommended using “race-neutral” GLI-Global prediction equations to interpret spirometry results. However, the unintended consequences for workers have not been fully evaluated. METHODS: We analyzed the impact of adopting GLI-Global on 24 hypothetical subjects, using on-line calculators to examine the effects on 1) larger vs. smaller predicted values; 2) Black, Southeast Asian, Northeast Asian, and White races; and 3) 80%, 100%, and 120% of race-specific predicted forced vital capacity (FVC). RESULTS: Race-specific predicted FVCs decline by group: White > NE Asian > SE Asian > Black, with a difference of 0.84 L between Blacks and Whites. GLI-Global Predicteds are midway between Blacks’ and Whites’. Workers at 80% of race-specific Predicted change the most when GLI-Global is employed: Blacks and SE Asians show declining %Predicted values and Z-scores and an increase in FVCs<LLN, while Whites and NE Asians show increasing %Predicted and Z-scores and a decrease in FVCs<LLN. CONCLUSIONS: Choice of prediction equation for use in occupational health practice differentially affects individuals in several groups: a) When fixed criteria are used for job placement and retention decisions, Black and SE Asian persons may be particularly adversely affected, while Whites and NE Asians will more likely exceed the fixed criteria; b) When fixed criteria are used for disability decisions, Black and SE Asian persons may look increasingly disabled, while White and NE Asian persons may now fail to qualify for disability; and c) Disparate effects are most prominent for persons with lung function measures in the lower portion of the normal range. Since occupational criteria are unlikely to change quickly, clinicians and policymakers should consider the real-world implications of mandating or recommending specific equations.