Reform and Remedy for Imprecision and Inequity - Ending the Race-Based Evaluation of Occupational Pulmonary Impairment

Details

• Journal Article:
  New England Journal of Medicine
• Personal Author:
  Khazanchi, Rohan ; Stanojevic, Sanja ; Hines, Stella E. ; Bhakta, Nirav R.
• Description:
  The use of race as a variable in clinical and administrative algorithms has increasingly been questioned by medical trainees, patients, clinicians, researchers, and policymakers. In May 2025, federal regulations under Section 1557 of the Affordable Care Act began requiring that all covered health care entities, including clinicians and health systems, demonstrate "'reasonable efforts' to identify and mitigate discrimination caused by the use of patient care decision support tools." In the guidance underlying these regulations, the Department of Health and Human Services (HHS) explicitly identifies adverse outcomes associated with the use of race-based equations for interpreting pulmonary-function tests (PFTs). Race-based PFT guidelines were taught to clinicians for decades, even as questions arose about their validity and the implications of their use. Social scientists and historians were among the first to recognize that racial differences in measured lung capacity had been used as justification for the enslavement of Black people and for claims of racial hierarchy. Within medicine, a growing consensus gradually emerged that the field should end inaccurate and imprecise uses of race as a standalone proxy for biologic or genetic traits. Pursuant to a 2023 consensus statement from the American Thoracic Society (ATS) and endorsed by the European Respiratory Society (ERS), health care systems have now begun shifting to the race-neutral Global Lung Function Initiative (GLI) PFT reference equation. Significant gaps persist, however, in the implementation of race-neutral PFT equations in the United States and worldwide, because race has long been embedded in PFT interpretation. Moreover, the isolated replacement of race-based reference equations in individual PFT laboratories does not address specific and long-standing challenges associated with assessing work-related pulmonary impairment for disability compensation. Understanding the historical, clinical, and regulatory contexts that led to imprecise and inequitable evaluations of occupational pulmonary-function impairment can help identify implicated stakeholders and next steps to remedy the measurable health and economic consequences of race-based PFT equations.
• Subjects:
  Lung Occupational Health Respiratory System Safety
• Keywords:
  Regulations; Discrimination; Pulmonary function; Lung function; Occupational diseases; Economic consequences; Recommendations
• Source:
  N Engl J Med 2025 Jul; 393(5):508-514
• ISSN:
  0028-4793
• Document Type:
  Text
• Genre:
  Journal Article
• Place as Subject:
  Massachusetts ; West Virginia ; California ; Boston Region [OSHA] ; Philadelphia Region [OSHA] ; San Francisco Region [OSHA]
• CIO:
  National Institute for Occupational Safety and Health (NIOSH)
• Division:
  RHD - Respiratory Health Division
• Topic:
  Workplace Safety & Health
• Location:
  North America
• Pages in Document:
  7 pdf pages
• Volume:
  393
• Issue:
  5
• NIOSHTIC Number:
  nn:20071364
• Federal Fiscal Year:
  2025
• Peer Reviewed:
  True
• Collection(s):
  National Institute for Occupational Safety and Health
• Main Document Checksum:
  urn:sha-512:648c398723ed66817332ddde24d73e5718274f286b264394e6249757235dfd4f99ab84c4128b45933fef5f3c7d02ce4f4cd82494ee7a22824de6d5b82b50245d
• Download URL:
  https://stacks.cdc.gov/view/cdc/258839/cdc_258839_DS1.pdf
• File Type:
  [PDF - 822.81 KB ]