Performance of american thoracic society-recommended spirometry reference values in a multiethnic sample of adults the multi-ethnic study of atherosclerosis (MESA) lung study

John L. Hankinson, Steven M. Kawut, Eyal Shahar, Lewis J. Smith, Karen Hinckley Stukovsky, R. Graham Barr

Research output: Contribution to journalArticle

160 Scopus citations

Abstract

Background: The American Thoracic Society recommends race-specific spirometric reference values from the National Health and Nutrition Survey (NHANES) III for clinical evaluation of pulmonary function in whites, African-Americans, and Mexican-Americans in the United States and a correction factor of 0.94 for Asian-Americans. We aimed to validate the NHANES III reference equations and the correction factor for Asian-Americans in an independent, multiethnic sample of US adults. Methods: The Multi-Ethnic Study of Atherosclerosis (MESA) recruited self-identified non-Hispanic white, African-American, Hispanic, and Asian-American participants aged 45 to 84 years at six US sites. The MESA-Lung Study assessed prebronchodilator spirometry among 3,893 MESA participants who performed acceptable tests, of whom 1,068 were asymptomatic healthy nonsmokers who performed acceptable spirometry. Results: The 1,068 participants were mean age 65 ± 10 years, 60% female, 25% white, 20% African-American, 23% Hispanic, and 32% Asian-American. Observed values of FEV1, FEV6, and FVC among whites, African-Americans, and Hispanics of Mexican origin in MESA-Lung were slightly lower than predicted values based on NHANES III. Observed values among Hispanics of non-Mexican origin were consistently lower. Agreement in classification of participants with air-flow obstruction based on lower limit of normal criteria was good (overall κ = 0.88). For Asian-Americans, a correction factor of 0.88 was more accurate than 0.94. Conclusions: The NHANES III reference equations are valid for use among older adults who are white, African-American, or Hispanic of Mexican origin. Comparison of white and Asian-American participants suggests that a correction factor of 0.88, applied to the predicted and lower limits of normal values, is more appropriate than the currently recommended value of 0.94.

Original languageEnglish (US)
Pages (from-to)138-145
Number of pages8
JournalCHEST
Volume137
Issue number1
DOIs
StatePublished - Jan 1 2010

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine
  • Critical Care and Intensive Care Medicine
  • Cardiology and Cardiovascular Medicine

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