Key PointsQuestionIs omitting race and ethnicity as a predictor in colorectal cancer recurrence risk prediction models associated with racial and ethnic bias?FindingsIn this prognostic study with 4230 patients with colorectal cancer, 4 prediction models for risk of postoperative cancer recurrence were developed and validated. Explicitly considering race and ethnicity as a predictor improved model predictive performance among racial and ethnic minority patients and increased algorithmic fairness in multiple performance measures.MeaningThese findings suggest that implementing clinical risk models that simply omit race and ethnicity may result in worse prediction accuracy for racial and ethnic minority groups that may lead to inappropriate care recommendations that ultimately contribute to health disparities.