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Original Research: LUNG FUNCTION |

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, PhD; Steven M. Kawut, MD, MS, FCCP; Eyal Shahar, MD, MPH; Lewis J. Smith, MD; Karen Hinckley Stukovsky, MS; R. Graham Barr, MD, DrPH
Author and Funding Information

From Hankinson Consulting, Inc. (Dr Hankinson), Valdosta, GA; Department of Medicine and the Center for Clinical Epidemiology and Biostatistics (Dr Kawut), University of Pennsylvania School of Medicine, Philadelphia, PA; Division of Epidemiology and Biostatistics (Dr Shahar), University of Arizona, Tucson, AZ; Department of Medicine (Dr Smith), Northwestern University, Chicago, IL; Department of Biostatistics (Ms Stukovsky), University of Washington, Seattle, WA; and the Departments of Medicine and Epidemiology (Dr Barr), Columbia University Medical Center, New York, NY.

Correspondence to: R. Graham Barr, MD, DrPH, Columbia University Medical Center, 630 West 168th Street, PH 9 East - Room 105, New York, NY 10032; e-mail: rgb9@columbia.edu


Funding/Support: This study was funded by the National Institutes of Health/National Heart, Lung, and Blood Institute [grants R01 HL-077612 and R01 HL-075476 and contracts N01-HC95159-169].

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (www.chestjournal.org/site/misc/reprints.xhtml).


© 2010 American College of Chest Physicians


Chest. 2010;137(1):138-145. doi:10.1378/chest.09-0919
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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 airflow 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.

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