Assessing the dependence of sensitivity and specificity on prevalence in meta-analysis

We consider modeling the dependence of sensitivity and specificity on the disease prevalence in diagnostic accuracy studies.Many meta-analyses compare test accuracy across studies and fail to incorporate the possible connection between the accuracy measures and the prevalence.We propose a Pearson type correlation coefficient and an estimating equation.based regression framework to help understand such a practical dependence.The results we derive may then be used to better interpret the results from meta-analyses.In the biomedical examples analyzed in this paper, the diagnostic accuracy of biomarkers are shown to be associated with prevalence, providing insights into the utility of these biomarkers in low- and high-prevalence populations.