Changes in interpretation of spirometry by implementing the GLI 2012 reference equations: impact on patients tested in a hospital-based PFT lab in a large metropolitan city
Bibliographic record
Abstract
Background The Global Lung Function Initiative (GLI-2012) focused on race/ethnicity as an important factor in determining reference values. This study evaluated the effects of changing from Canadian reference equations developed from an all-Caucasian cohort with European ancestry to the GLI-2012 on the interpretation of spirometry in a multiethnic population and aimed to identify the ethnic groups affected by discrepant interpretations. Methods Clinically indicated spirometry in a multiethnic population (aged 20–80 years) collected from 2018 to 2021 was analysed. The predicted and lower limit of normal (LLN) values were calculated using three sets of reference equations: Canadian, GLI-race/ethnic-based (GLI-Race) and GLI-race/ethnic-neutral (GLI-Other). We compared the prevalence of concordance in the abnormal diagnoses (defined as <LLN) for forced vital capacity (FVC), forced expiratory volume in 1 s (FEV 1 ), and FEV 1 /FVC among the three reference values, and evaluated whether race/ethnicity was associated with discordance. Results Data from 406 participants were evaluated (non-Caucasian 43.6%). There was 85%–87% concordance for normal/abnormal FVC and FEV 1 interpretations among the Canadian, GLI-Race and GLI-Other reference equations. In all ethnic groups, application of the Canadian references for interpretation led to a higher prevalence of abnormal (<LLN) FVC and FEV 1 compared with GLI-Race and GLI-Other. This trend was more prominent in Black, South-East Asian and Mixed/other ethnic groups when comparing the Canadian to the GLI-Race equations. In contrast, the discordance rates were similar among ethnic groups when compared with the GLI-Other reference equations. Interpretation of FEV 1 /FVC had a high rate of agreement among all equations. Conclusion Interpretation using Canadian reference equations was associated with a higher prevalence of restrictive physiology compared with the GLI-2012 equations, particularly if the GLI-Race were used. These observations were mostly found in non-white Caucasian groups, highlighting the need to choose reference equations that reflect closely the ethnic mix of the population being evaluated in order to optimise patient management.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.011 | 0.004 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.002 | 0.004 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.001 | 0.002 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".