• M Hassan Murad, Lifeng Lin, Haitao Chu, Bashar Hasan, Reem A Alsibai, Alzhraa S Abbas, Reem A Mustafa, and Zhen Wang.
• Evidence-Based Practice Center (Murad, Hasan, Alsibai, Abbas, Wang), Mayo Clinic, Rochester, Minn.; Department of Epidemiology and Biostatistics (Lin), University of Arizona, Tucson, Ariz.; Statistical Research and Data Science Center (Chu), Pfizer, New York, NY; Department of Internal Medicine (Mustafa), University of Kansas Health System, Kansas City, Kan. Murad.mohammad@mayo.edu.
• CMAJ. 2023 Jul 17; 195 (27): E925E931E925-E931.

BackgroundSensitivity and specificity are characteristics of a diagnostic test and are not expected to change as the prevalence of the target condition changes. We sought to evaluate the association between prevalence and changes in sensitivity and specificity.MethodsWe retrieved data from meta-analyses of diagnostic test accuracy published in the Cochrane Database of Systematic Reviews (2003-2020). We used mixed-effects random-intercept linear regression models to evaluate the association between prevalence and logit-transformed sensitivity and specificity. The model evaluated all meta-analyses as nested within each systematic review.ResultsWe analyzed 6909 diagnostic test accuracy studies from 552 meta-analyses that were included in 92 systematic reviews. For sensitivity, compared with the lowest quartile of prevalence, the second, third and fourth quartiles were associated with significantly higher odds of identifying a true positive case (odds ratio [OR] 1.17, 95% confidence interval [CI] 1.09-1.26; OR 1.32, 95% CI 1.23-1.41; OR 1.47, 95% CI 1.37-1.58; respectively). For specificity, compared with the lowest quartile of prevalence, the second, third and fourth quartiles were associated with significantly lower odds of identifying a true negative case (OR 0.74, 95% CI 0.69-0.80; OR 0.65, 95% CI 0.60-0.70; OR 0.47, 95% CI 0.44-0.51; respectively). Pooled regression coefficients from bivariate models conducted within each meta-analysis showed that prevalence was positively associated with sensitivity and negatively associated with specificity. Findings were consistent across subgroups.InterpretationIn this large sample of diagnostic studies, higher prevalence was associated with higher estimated sensitivity and lower estimated specificity. Clinicians should consider the implications of disease prevalence and spectrum when interpreting the results from studies of diagnostic test accuracy.© 2023 CMA Impact Inc. or its licensors.

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