Recommendations for Using Causal Diagrams to Study Racial Health Disparities

• Published in: American journal of epidemiology Vol. 191; no. 12; pp. 1981 - 1989
• Main Authors: Howe, Chanelle J, Bailey, Zinzi D, Raifman, Julia R, Jackson, John W
• Format: Journal Article
• Language: English
• Published: United States Oxford University Press 19.11.2022; Oxford Publishing Limited (England)
• Subjects: Causality; Discrimination; Health disparities; Health Status Disparities; Healthcare Disparities; Humans; Population Health; Population studies; Race; Racism; United States; United States; race relations; health status disparities; racism; epidemiologic methods
• ISSN: 0002-9262; 1476-6256; 1476-6256
• DOI: 10.1093/aje/kwac140

Abstract There have been calls for race to be denounced as a biological variable and for a greater focus on racism, instead of solely race, when studying racial health disparities in the United States. These calls are grounded in extensive scholarship and the rationale that race is not a biological variable, but instead socially constructed, and that structural/institutional racism is a root cause of race-related health disparities. However, there remains a lack of clear guidance for how best to incorporate these assertions about race and racism into tools, such as causal diagrams, that are commonly used by epidemiologists to study population health. We provide clear recommendations for using causal diagrams to study racial health disparities that were informed by these calls. These recommendations consider a health disparity to be a difference in a health outcome that is related to social, environmental, or economic disadvantage. We present simplified causal diagrams to illustrate how to implement our recommendations. These diagrams can be modified based on the health outcome and hypotheses, or for other group-based differences in health also rooted in disadvantage (e.g., gender). Implementing our recommendations may lead to the publication of more rigorous and informative studies of racial health disparities.