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.

中文翻译：

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重新评估种族在计算尿路感染风险中的作用：系统评价和荟萃分析。

重要性 先前报告的预测模型包括儿童种族来估计尿路感染 (UTI) 的风险，但具有种族意识的医学鼓励研究种族如何可能成为其他因素的替代因素，而这些因素应该用于风险预测。目标 系统地回顾现有文献以评估种族和 UTI 之间关联的稳健性，并评估其他变量是否可以替代种族作为先前开发的预测工具中的变量而不对其准确性产生不利影响。数据来源 MEDLINE 的搜索截止日期为 2021 年 5 月 28 日。研究选择 包括根据种族报告 18 岁以下儿童 UTI 患病率数据的英语研究。数据提取和综合 两名独立审查员评估了偏倚风险和提取数据的研究。随机效应模型用于汇总比值比，元回归用于探索异质性。非黑人儿童与黑人儿童 UTI 的主要结果和衡量标准。结果 纳入了 16 项研究（17 845 名儿童）。在包括 11 项研究的主要分析中，非黑人儿童 UTI 的合并比值比比黑人儿童高 2.44 倍（95% CI，1.87-3.20）。在偏倚风险较低或极低的研究中，非黑人儿童的相应优势比比黑人儿童高 4.84 倍（95% CI，3.16-7.41；I2 = 0%）。用 UTI 病史和发烧持续时间代替种族会产生具有相似准确性的模型（训练队列：总体敏感性，96% [95% CI, 94%-98%]；总体特异性，35% [95%, 32%-38%]；接受者操作特征曲线下的总面积，0.80 [95% CI，0.77-0.82]；验证队列：总体敏感性，97% [95% CI, 90%-100%]；总体特异性，32% [95% CI, 26%-37%]；接受者操作特征曲线下的总面积，0.84 [95% CI，0.77-0.92]）。结论和相关性 尽管之前的研究表明种族和 UTI 之间存在关联，但由于在决策模型中包含种族相关的问题，我们在之前开发的风险预测中用 UTI 病史和发烧持续时间替换了种族变量模型并发现相似的准确性。整体敏感性，97% [95% CI, 90%-100%]；总体特异性，32% [95% CI, 26%-37%]；接受者操作特征曲线下的总面积，0.84 [95% CI，0.77-0.92]）。结论和相关性 尽管之前的研究表明种族和 UTI 之间存在关联，但由于在决策模型中包含种族相关的问题，我们在之前开发的风险预测中用 UTI 病史和发烧持续时间替换了种族变量模型并发现相似的准确性。整体敏感性，97% [95% CI, 90%-100%]；总体特异性，32% [95% CI, 26%-37%]；接受者操作特征曲线下的总面积，0.84 [95% CI，0.77-0.92]）。结论和相关性 尽管之前的研究表明种族和 UTI 之间存在关联，但由于在决策模型中包含种族相关的问题，我们在之前开发的风险预测中用 UTI 病史和发烧持续时间替换了种族变量模型并发现相似的准确性。