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• Posted June 2, 2023

Software Bias Misses Lung Problems in Black Men, Study Finds

A common test for lung function may be missing lung problems in Black men, leading to under-diagnosis and insufficient care.

A new study from the University of Pennsylvania estimates that as many as 40% more Black male patients would have been diagnosed with breathing problems if racial bias hadn't been built into diagnosing software.

At issue is part of a long-held assumption that there were natural racial differences in health. These became a part of modern guidelines and computer algorithms, the Associated Press reported.

The assumptions show up not just in evaluating lung function but in other areas of health, such as heart failure and kidney function.

It was assumed that Black people's lungs were naturally worse than white people's lungs, an assumption adjusted for in the software, the researchers said.

This study, offering a real-world example of these wrong assumptions, is “exciting” and also “what we'd expect,” said Dr. Darshali Vyas, a pulmonary care doctor at Massachusetts General Hospital in Boston, told the AP.

In the study, researchers led by Dr. Alexander Moffett, a pulmonology, allergy and critical care fellow at UPenn's Perelman School of Medicine in Philadelphia, looked at a test that often uses a spirometer to assess how quickly someone can inhale and exhale.

This test can indicate whether a patient may need more testing or care for a variety of breathing disorders, including asthma, chronic obstructive pulmonary disorder (COPD) or lung scarring.

Researchers examined the cases of 2,700 Black men and 5,700 white men tested by the University of Pennsylvania Health System between 2010 and 2020.

They compared results under the existing race-based algorithm and a new algorithm, finding there would be 400 additional cases of lung problems in Black men without the race-based calculations.

Although doctors also consider symptoms, X-rays, lab work and family history when diagnosing someone with lung conditions, this testing is still important, “especially when patients are borderline,” Dr. Albert Rizzo, chief medical officer at the American Lung Association.

These race-based algorithms may make it less likely that Black people will get quickly started on needed medications or be referred for procedures, including lung transplants, said Vyas, who was an author of an earlier, influential study that showed examples of race-based assumptions in decisions and patient care.

Some other algorithms have been changed to drop race-based assumptions, the AP reported. It may take time to change the one for lung function, Vyas said.

The American Thoracic Society, representing lung-care doctors, has recommended replacing race-based adjustments. It also asked for more research to be sure that changes don't lead to overcorrecting and over-diagnosis, the AP reported.

The findings were published June 1 in the journal JAMA Network Open.

More information

The American Lung Association has more on a multitude of lung conditions.

SOURCE: Associated Press