Reassessment of the Role of Race in Calculating the Risk for Urinary Tract Infection: A Systematic Review and Meta-analysis

Abstract

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.

Figure 1.. Flowsheet Describing Screening of Studies for the Quick Review

UTI indicates urinary tract infection.

Figure 2.. Meta-analysis of 16 Studies to Date With Data on Odds of Urinary Tract Infection (UTI) According to Race and Stratified by Whether Race of Hispanic Children Was Ascertained

The sizes of the data markers are proportional to the weight of the study. PECARN indicates Pediatric Emergency Care Applied Research Network. ^aUnpublished study examining prevalence of UTI among 228 children aged 24 months or younger who were not receiving antibiotics in the past 5 days presenting with fever to outpatient practices or express care offices associated with Children’s Hospital of Pittsburgh who were evaluated for UTI by bladder catheterization. UTI was defined as in the UTICalc study.