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Comment & Response
July 6, 2020

Perspectives on Urinary Tract Infection and Race

Author Affiliations
  • 1Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
  • 2Boston Children’s Hospital, Boston, Massachusetts
  • 3Children’s Minnesota, Minneapolis
JAMA Pediatr. Published online July 6, 2020. doi:10.1001/jamapediatrics.2020.1156

To the Editor We are in agreement with Kowalsky et al1 in their opinion that racism has no place in medicine; we should recognize and address implicit and explicit bias; and all children deserve excellent medical care. However, we respectfully disagree that the American Academy of Pediatrics Urinary Tract Infection (UTI) Guideline is an example of racism in medicine. The authors correctly point out how fraught the use of race in medicine is, particularly the fact that it is a socio-cultural construct rather than a biological one, along with the challenge of accurately classifying patient “race.” However, when numerous large prevalence studies of febrile infants using various methods of racial identification have independently and consistently found a higher prevalence of UTI in febrile white infants,2-4 the idea that this is owing solely to some sampling, measurement, or other bias is very unlikely. When confronted with a puzzling but statistically valid observation, our challenge is to explain it rather than ignore it.