Department of Medicine, University of California, San Diego Health, San Diego.
School of Medicine, University of California, San Diego.
JAMA Netw Open. 2023 Jan 3;6(1):e2250654. doi: 10.1001/jamanetworkopen.2022.50654.
Social needs interventions aim to improve health outcomes and mitigate inequities by addressing health-related social needs, such as lack of transportation or food insecurity. However, it is not clear whether these studies are reducing racial or ethnic inequities.
To understand how studies of interventions addressing social needs among multiracial or multiethnic populations conceptualize and analyze differential intervention outcomes by race or ethnicity.
Sources included a scoping review of systematic searches of PubMed and the Cochrane Library from January 1, 1995, through November 29, 2021, expert suggestions, and hand searches of key citations. Eligible studies evaluated interventions addressing social needs; reported behavioral, health, or utilization outcomes or harms; and were conducted in multiracial or multiethnic populations. Two reviewers independently assessed titles, abstracts, and full text for inclusion. The team developed a framework to assess whether the study was "conceptually thoughtful" for understanding root causes of racial health inequities (ie, noted that race or ethnicity are markers of exposure to racism) and whether analyses were "analytically informative" for advancing racial health equity research (ie, examined differential intervention impacts by race or ethnicity).
Of 152 studies conducted in multiracial or multiethnic populations, 44 studies included race or ethnicity in their analyses; of these, only 4 (9%) were conceptually thoughtful. Twenty-one studies (14%) were analytically informative. Seven of 21 analytically informative studies reported differences in outcomes by race or ethnicity, whereas 14 found no differences. Among the 7 that found differential outcomes, 4 found the interventions were associated with improved outcomes for minoritized racial or ethnic populations or reduced inequities between minoritized and White populations. No studies were powered to detect differences.
In this review of a scoping review, studies of social needs interventions in multiracial or multiethnic populations were rarely conceptually thoughtful for understanding root causes of racial health inequities and infrequently conducted informative analyses on intervention effectiveness by race or ethnicity. Future work should use a theoretically sound conceptualization of how race (as a proxy for racism) affects social drivers of health and use this understanding to ensure social needs interventions benefit minoritized racial and ethnic groups facing social and structural barriers to health.
社会需求干预旨在通过解决与健康相关的社会需求（如缺乏交通或粮食不安全）来改善健康结果并减轻不平等现象。然而，目前尚不清楚这些研究是否能减少种族或民族不平等现象。
了解多种族或多民族人群中针对社会需求的干预措施研究如何从种族或民族角度来理解和分析干预结果的差异。
来源包括对 1995 年 1 月 1 日至 2021 年 11 月 29 日期间 PubMed 和 Cochrane 图书馆的系统检索进行的范围审查、专家建议以及对关键引文的手工检索。符合条件的研究评估了针对社会需求的干预措施；报告了行为、健康或利用结果或危害；并在多种族或多民族人群中进行。两名审查员独立评估了纳入标准的标题、摘要和全文。该团队制定了一个框架，以评估研究是否“从概念上深入思考”了解造成种族健康不平等的根本原因（即指出种族或民族是接触种族主义的标志），以及分析是否“在分析上提供信息”以推进种族健康公平研究（即，研究种族或民族对干预效果的差异影响）。
在针对多种族或多民族人群进行的 152 项研究中，有 44 项研究在其分析中纳入了种族或民族因素；其中，只有 4 项（9%）研究具有概念上的深度。21 项研究（14%）具有分析信息。21 项分析信息丰富的研究中有 7 项报告了种族或民族差异的结果，而 14 项研究则没有发现差异。在发现差异的 7 项研究中，有 4 项研究发现干预措施与少数族裔种族或族裔群体的改善结果相关，或减少了少数族裔和白人之间的不平等现象。没有研究具有检测差异的能力。
在这项对范围审查的综述中，多种族或多民族人群中的社会需求干预研究很少从概念上深入思考造成种族健康不平等的根本原因，也很少对种族或民族对干预效果的影响进行有信息意义的分析。未来的工作应该使用一个理论上合理的概念化方法来理解种族（作为种族主义的代表）如何影响健康的社会驱动因素，并利用这种理解来确保社会需求干预措施使面临社会和结构性健康障碍的少数族裔和少数民族受益。
