Pediatric UTI Risk Assessments and Race

While we’re focused on COVID-19, it’s important not to forget the common infectious disease burdens—from influenza to pneumonia to infections. Urinary tract infections (UTIs) are also one of those infectious disease issues we often overlook or brush to the side, especially in a pandemic state. Matha Medina and Edgardo Castillo-Pino noted that “urinary tract infections (UTIs) are the most common outpatient infections, with a lifetime incidence of 50−60% in adult women.”

To better understand UTIs and the risk for them, a research study was recently published in JAMA Pediatrics. The study sought to address and reassess the role of race in calculation of UTI risks in children. Previously, the predictive modeling for childhood UTIs included race but the authors emphasized that this may be more related to race as a proxy for other factors that increase risk. To address this very question, the authors performed a systematic review to truly assess just how strong the association between race and UTIs in children may be.

Moreover, the authors sought to understand if there were other variables that could replace race as a more effective variable in predicting UTIs in children. The authors noted that “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]).”

Ultimately, the authors emphasized that it was a viable option to replace rate in these predictive models with history of UTI and duration of fever, without impacting the accuracy. This speaks to a bigger need in research and epidemiological studies to truly understand and correctly apply race as a variable, especially without understanding how it too often acts as a proxy for issues we’re inherently ignoring.

As the authors noted, “study, the variable race was replaced with history of UTI and duration of fever in a previously developed risk prediction model and accuracy was similar; the association between race and UTIs observed in many previous studies still requires explanation as we shift clinical and translational science toward race-conscious medicine.”

Globally, UTIs represent a significant issue that we will increasingly need to focus on, especially in discussions surrounding antimicrobial resistance and stewardship. On an international scale, community-associated UTI prevalence is 0.7%, with the main risk factors being age, history of UTI, sexual activity and diabetes.

Healthcare-associated UTIs also represent a significant disease burden and our knowledge of both community and healthcare-associated UTIs is even less when it comes to pediatric cases. We will increasingly need to address this health issue in children and what increases and decrease the risk for acquisition.