Are “race-neutral” lung volume prediction equations appropriate? A critical review of the contributions of anthropometric differences and socioeconomic factors to lung volumes

Ostensibly healthy individuals of different geographic ancestries have appreciably different spirometric volumes for any specific sex, age and height. Traditionally, ancestry has been felt to be an integral component of prediction formulas for pulmonary function. A more recently stated alternate view is that socioeconomic status is the primary correlate of these differences; in other words, these differences are acquired, not inherent. Adopting this view, in 2023 the American Thoracic Society and European Respiratory Society recommended that all individuals, regardless of ancestry, should have spirometry assessed using a single set of "race-neutral" prediction values produced by weighted averaging of previously defined ancestral groups. We re-review the literature and couple it with anthropological data to support the conclusion that ancestral differences are primarily inherent and thus should be included in volume prediction equations for healthy individuals. In support of this, we document not only physiological evidence, but also discuss the role of human thoracic morphology in the light of ecogeographic variation that has arisen due to our diverse evolutionary histories.