Am J Epidemiol. 2022 Nov 19;191(12):1981-1989. doi: 10.1093/aje/kwac140.
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.
人们呼吁谴责种族是一种生物学变量，并在研究美国种族健康差异时，更多地关注种族主义，而不仅仅是种族。这些呼吁的基础是广泛的学术研究和理论，即种族不是生物学变量，而是社会构建的，结构性/制度性种族主义是与种族相关的健康差异的根本原因。然而，在如何将这些关于种族和种族主义的主张最好地纳入流行病学家长期用于研究人口健康的工具（如因果关系图）方面，仍然缺乏明确的指导。我们提供了明确的建议，使用因果关系图来研究种族健康差异，这些建议是基于这些呼吁提出的。这些建议认为健康差异是与社会、环境或经济劣势相关的健康结果差异。我们提出了简化的因果关系图来说明如何实施我们的建议。可以根据健康结果和假设，或者基于劣势的其他基于群体的健康差异（例如，性别）来修改这些图表。实施我们的建议可能会导致更严格和信息更丰富的种族健康差异研究的发表。
