Key PointsQuestionHow do race-neutral reference equations affect pulmonary function test interpretation?FindingsIn this cross-sectional study of 8431 Black and White individuals, the use of race-neutral reference equations for pulmonary function test interpretation, compared with the race-specific reference equations that are currently recommended, resulted in an increase in the percentage of Black individuals identified with restrictive ventilatory impairments from 26.8% to 37.5% and an increase in the percentage of Black individuals identified with nonspecific ventilatory impairments from 3.2% to 6.5%. The percentage of White individuals identified with restrictive impairments decreased from 22.6% to 18.0%, while the percentage of White individuals identified with nonspecific impairments decreased from 8.7% to 4.0%.MeaningIn this study, the use of race-neutral reference equations was associated with an increase in the prevalence and severity of ventilatory impairments in Black patients.