Historic Use of Race-Based Spirometry Values Lowered Transplant Priority for Black Patients.
disparities
spirometry
transplant
Journal
Chest
ISSN: 1931-3543
Titre abrégé: Chest
Pays: United States
ID NLM: 0231335
Informations de publication
Date de publication:
11 Oct 2023
11 Oct 2023
Historique:
received:
10
06
2023
revised:
20
09
2023
accepted:
05
10
2023
pubmed:
14
10
2023
medline:
14
10
2023
entrez:
13
10
2023
Statut:
aheadofprint
Résumé
The lung allocation score (LAS) is a tool used to prioritize patients for lung transplantation. For patients with interstitial lung diseases (ILDs), spirometry data are used for the LAS calculation. Spirometry values such as a FVC are subjected to race-specific equations that determine expected values. The effect of race-specific equations in LAS score remains unknown. Did the use of a race-based spirometry equation lead to longer waitlist times for Black patients? We performed a retrospective analysis of patients listed for lung transplantation from 2005 through 2020 using publicly available data from the United Network for Organ Sharing. We recalculated LAS scores for Black patients using White-specific equations with the available variables. The primary objective was to evaluate the effect of race-specific equations on LAS scores and time on the transplant waitlist. A total of 33,845 patients listed for lung transplantation were included in the analysis. White patients were listed at lower LAS scores, a higher proportion of White patients underwent transplantation, and White patients died on the waitlist at lower rates. When recalculating LAS scores using White-specific equations, Black patients with ILD had up to a 1.9-point higher score, which resulted in additional waitlist time. Race-specific equations led to longer wait times in Black patients listed for lung transplantation. The use of race-based equations widened already known disparities in pulmonary transplantation.
Sections du résumé
BACKGROUND
BACKGROUND
The lung allocation score (LAS) is a tool used to prioritize patients for lung transplantation. For patients with interstitial lung diseases (ILDs), spirometry data are used for the LAS calculation. Spirometry values such as a FVC are subjected to race-specific equations that determine expected values. The effect of race-specific equations in LAS score remains unknown.
RESEARCH QUESTION
OBJECTIVE
Did the use of a race-based spirometry equation lead to longer waitlist times for Black patients?
STUDY DESIGN AND METHODS
METHODS
We performed a retrospective analysis of patients listed for lung transplantation from 2005 through 2020 using publicly available data from the United Network for Organ Sharing. We recalculated LAS scores for Black patients using White-specific equations with the available variables. The primary objective was to evaluate the effect of race-specific equations on LAS scores and time on the transplant waitlist.
RESULTS
RESULTS
A total of 33,845 patients listed for lung transplantation were included in the analysis. White patients were listed at lower LAS scores, a higher proportion of White patients underwent transplantation, and White patients died on the waitlist at lower rates. When recalculating LAS scores using White-specific equations, Black patients with ILD had up to a 1.9-point higher score, which resulted in additional waitlist time.
INTERPRETATION
CONCLUSIONS
Race-specific equations led to longer wait times in Black patients listed for lung transplantation. The use of race-based equations widened already known disparities in pulmonary transplantation.
Identifiants
pubmed: 37832783
pii: S0012-3692(23)05565-4
doi: 10.1016/j.chest.2023.10.009
pii:
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Informations de copyright
Copyright © 2023 American College of Chest Physicians. All rights reserved.
Déclaration de conflit d'intérêts
Financial/Nonfinancial Disclosures None declared.