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Review
. 2018 Apr 1:39:169-188.
doi: 10.1146/annurev-publhealth-040617-014230. Epub 2018 Jan 12.

Relative Roles of Race Versus Socioeconomic Position in Studies of Health Inequalities: A Matter of Interpretation

Amani M Nuru-Jeter  1   2 , Elizabeth K Michaels  2 , Marilyn D Thomas  2 , Alexis N Reeves  2 , Roland J Thorpe Jr  3 , Thomas A LaVeist  4
Affiliations
Review

Relative Roles of Race Versus Socioeconomic Position in Studies of Health Inequalities: A Matter of Interpretation

Amani M Nuru-Jeter et al. Annu Rev Public Health. .

Abstract

An abundance of research has documented health inequalities by race and socioeconomic position (SEP) in the United States. However, conceptual and methodological challenges complicate the interpretation of study findings, thereby limiting progress in understanding health inequalities and in achieving health equity. Fundamental to these challenges is a lack of clarity about what race is and the implications of that ambiguity for scientific inquiry. Additionally, there is wide variability in how SEP is conceptualized and measured, resulting in a lack of comparability across studies and significant misclassification of risk. The objectives of this review are to synthesize the literature regarding common approaches to examining race and SEP health inequalities and to discuss the conceptual and methodological challenges associated with how race and SEP have been employed in public health research. Addressing health inequalities has become increasingly important as the United States trends toward becoming a majority-minority nation. Recommendations for future research are presented.

Keywords: health inequalities; race; social determinants of health; social epidemiology; socioeconomic position; socioeconomic status.

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Figures

Figure 1
Figure 1
Comparison of the proportion of journal articles that used race or ethnicity to stratify or adjust for in analysis. Adapted with permission from Reference , American Journal of Epidemiology © 2004; 159(6):611–9. Comstock RD et al. Four-year review of the use of race and ethnicity in epidemiologic and public health research. Published by Oxford University Press. Printed with permission. All rights reserved.
Figure 2
Figure 2
A framework for understanding the relationship between race and health. Adapted with permission from Reference , Summary of the CDC/ATSDR Workshop © 1993. Use of race and ethnicity in public health surveillance. Published by Prevention at the Centers for Disease Control. All rights reserved.
Figure 3
Figure 3
Time-dependent socioeconomic status pathways over the life course. Direct effects of race (R) on health (Y) (the pink pathway) and indirect effects through adult SES (the blue pathways), where both SES0 (family/parent SES) and NSES0 (neighborhood socioeconomic status) contribute to adult SES. Adapted with permission from Epidemiology © 2014; 25(4):473. VanderWeele TJ, Robinson WR. On the causal interpretation of race in regressions adjusting for confounding and mediating variables. Published by Wolters Kluwer Health, Inc. Printed with permission. All rights reserved. http://journals.lww.com/epidem/pages/default.aspx
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