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Excluding Race From Lung Function Testing Could Increase Disability Benefits for Black Veterans

Adjusting lung function assessments to exclude race as a factor—a shift advocated by health equity proponents—would lead to a reclassification of lung disease severity for nearly half a million Black Americans. Consequently, Black veterans might receive over $1 billion in additional disability benefits, according to a study published in the New England Journal of Medicine.

Context and Background:

The use of race in clinical algorithms has sparked extensive debate and controversy. The American Thoracic Society (ATS) is among the many medical organizations addressing this issue. Last year, ATS suggested that racial adjustments in lung disease diagnosis could contribute to health disparities and recommended discontinuing their use, calling for more research on the impacts of such changes.

Study Presentation:

The new study, presented at the ATS annual meeting in San Diego, aims to quantify the effects of removing race from lung function equations. Raj Manrai, the study’s senior author and an assistant professor at Harvard Medical School, hopes the findings will help prepare clinicians and health systems for the potential influx of patients requiring reevaluation.

Anticipated Changes:

Nirav Bhakta, a pulmonologist at the University of California, San Francisco, described the study as a significant effort, providing a clear picture of the expected changes. Bhakta emphasized the need for additional tests and imaging to prevent mortality and suggested that remote, AI-driven spirometry could alleviate the burden on hospital labs.

Implementation at Hospitals:

Boston Medical Center (BMC) recently updated its spirometers to use race-neutral equations, requiring software updates and integration into electronic health records. Michael Ieong, who oversees BMC’s pulmonary function lab, noted that it will take time to assess the impact on patient volume.

Historical Context:

The racial correction in spirometry, adjusting readings by up to 15% for Black patients, has been controversial. Critics argue that it stems from outdated and racist science and is problematic given that race is not a biological category. James Diao, the study’s lead author, highlighted the significant clinical and financial implications of these adjustments.

Implications for Black Veterans:

Rohan Khazanchi, a co-author, urged Black patients previously assessed with race-based equations to seek reevaluation. The study found that using race-neutral equations could substantially increase disability payments for Black veterans, while potentially reducing benefits for white veterans.

Broader Impact:

The study indicates that 12.5 million Americans may experience changes in their lung impairment classification. For instance, an additional 430,000 Black people would be diagnosed with moderate to severe COPD, while 1.1 million fewer white patients would receive such diagnoses.

Financial Implications:

The Veterans Administration could see a 17% increase in disability payments for Black veterans, amounting to an annual redistribution of $1.94 billion among eligible veterans.

The study’s results compel a reevaluation of how eligibility for disability and occupational fitness is determined. The authors acknowledge that while some patients might gain access to new treatments, others could lose eligibility for certain procedures. Overall, the goal is to ensure that clinical decision support tools are evidence-based and serve all patients equitably.

Read the full original article by Usha Lee McFarling at STAT News here.

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