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Published on: December 1, 2017
Reassessment of the Role of Race in Calculating the Risk for Urinary Tract Infection: A Systematic Review and
Nader Shaikh1, Matthew C Lee1, Lynissa R Stokes2
1Division of General Academic Pediatrics, University of Pittsburgh School of Medicine, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania.
Insights
This study found that race is a proxy for other factors in predicting urinary tract infections (UTIs) in children. Replacing race with UTI history and fever duration in prediction models maintained accuracy, supporting race-neutral risk assessment.
Area of Science:
- Pediatric Medicine
- Epidemiology
- Health Equity
Background:
- Previous urinary tract infection (UTI) risk prediction models incorporated race.
- Race-conscious medicine necessitates examining race as a proxy for other factors.
- Investigating alternative variables for accurate UTI risk prediction is crucial.
Purpose of the Study:
- To systematically review the literature on the association between race and UTI in children.
- To assess if variables other than race can replace it in prediction tools without accuracy loss.
- To promote race-neutral risk prediction in pediatric UTI.
Main Methods:
- Systematic literature search of MEDLINE up to May 2021.
- Inclusion of English-language studies reporting UTI prevalence by race in children under 18.
- Data extraction, risk of bias assessment, and meta-analysis using random-effects models and meta-regression.
Main Results:
- Analysis of 16 studies (17,845 children) revealed a higher odds of UTI in non-Black children.
- In high-quality studies, the odds of UTI were significantly higher in non-Black children.
- Replacing race with UTI history and fever duration resulted in a prediction model with comparable accuracy.
Conclusions:
- The association between race and UTI exists, but race acts as a proxy for other factors.
- Substituting race with history of UTI and duration of fever in prediction models maintains predictive accuracy.
- This approach supports the development of more equitable risk prediction tools for pediatric UTIs.
Importance:
A previously reported prediction model included a child's race to estimate risk of urinary tract infection (UTI), but race-conscious medicine encourages investigating how race is likely to be a proxy for other factors that should instead be used for risk prediction.
Objectives:
To systematically review the available literature to evaluate the robustness of the association between race and UTI and to assess whether other variables could replace race as a variable in a previously developed prediction tool without adversely affecting its accuracy.
Data Source:
MEDLINE was searched through May 28, 2021.
Study Selection:
English-language studies that reported data on the prevalence of UTI according to race for children younger than 18 years were included.
Data Extraction And Synthesis:
Two independent reviewers assessed studies for risk of bias and abstracted data. Random-effects models were used to pool odds ratios, and meta-regression was used to explore heterogeneity.
Main Outcomes And Measures:
Odds of UTI among non-Black children vs Black children.
Results:
Sixteen studies (17 845 children) were included. In the primary analysis, which included 11 studies, the pooled odds ratio of UTI among non-Black children was 2.44-fold higher (95% CI, 1.87-3.20) than among Black children. The corresponding odds ratio in studies with low or very low risk of bias was 4.84-fold higher (95% CI, 3.16-7.41; I2 = 0%) among non-Black children than among Black children. Replacing race with history of UTI and duration of fever resulted in a model with similar accuracy (training cohort: overall sensitivity, 96% [95% CI, 94%-98%]; overall specificity, 35% [95%, 32%-38%]; overall area under the receiver operating characteristic curve, 0.80 [95% CI, 0.77-0.82]; validation cohort: overall sensitivity, 97% [95% CI, 90%-100%]; overall specificity, 32% [95% CI, 26%-37%]; overall area under the receiver operating characteristic curve, 0.84 [95% CI, 0.77-0.92]).
Conclusions And Relevance:
Although previous studies suggested that an association between race and UTI exists, because of the issues associated with the inclusion of race in decision models, we replaced the variable of race with history of UTI and duration of fever in a previously developed risk prediction model and found similar accuracy.
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