One clear example in pulmonary medicine is the utilization of race and ethnicity in the interpretation of pulmonary function tests (PFTs).
In 2023, CHEST developed a research statement focused on the use of race and ethnicity-specific reference equations in the interpretation of PFT results, exploring how this has been used (and misused) as a proxy for genetic ancestry, environmental factors, and other variables in assessing lung health.
The research statement included a comprehensive literature view of the evidence on the use of race in PFTs, identified clinical implications of the use and nonuse of race and ethnicity in PFT interpretation, and prioritized research questions that need to be answered to form the foundation for future clinical guidance in PFT interpretation.
In furthering this work, CHEST has participated in the Encoding Equity Alliance, a group of medical organizations working to drive change in clinical research by designing more accurate and equitable decision tools and advocating for the appropriate use of race in research design and clinical guidance. The Encoding Equity Alliance, with the support of the Council of Medical Specialty Societies and the Doris Duke Foundation, hosts a yearly summit that brings medical societies together to explore strategies for reconsidering race in clinical algorithms and assessing the inclusion of race as a biologic construct in clinical research and its impact on patient outcomes.
CHEST continues to participate in this yearly summit, most recently in the June 2025 meeting entitled “From Evidence to Impact.” This year’s summit explored strategies to audit and update clinical practice guidelines and assess the underlying evidence base to address how race may be used or misused in clinical guidance.
CHEST is also participating in the recently formed Encoding Equity Alliance Clinical and Specialty Societies Task Force. The goal of the task force is to develop a tool that can be used to adopt practices that recognize how the use and misuses of race and ethnicity in clinical guidelines and algorithms may help or harm health outcomes. Recommendations for the tool are based on evidence and the experiences of medical societies, including CHEST, that are already exploring the path toward greater health equity in evidence-based guidelines.
Through these efforts, CHEST is contributing to specific concepts around organizational commitment, evaluating existing guidelines and algorithms for the use and misuse of race and ethnicity, encouraging the adaptation and implementation of revised guidance that promotes health equity, and actively communicating the need for change.