Department of Sociology and Population Research Institute, Duke University, Durham, NC, USA.
Department of Sociology and Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
Demography. 2023 Jun 1;60(3):675-705. doi: 10.1215/00703370-10740718.
Racism drives population health inequities by shaping the unequal distribution of key social determinants of health, such as socioeconomic resources and exposure to stressors. Research on interrelationships among race, socioeconomic resources, stressors, and health has proceeded along two lines that have largely remained separate: one examining differential effects of socioeconomic resources and stressors on health across racialized groups (moderation processes), and the other examining the role of socioeconomic resources and stressors in contributing to racial inequities in health (mediation processes). We conceptually and analytically integrate these areas using race theory and a novel moderated mediation approach to path analysis to formally quantify the extent to which an array of socioeconomic resources and stressors-collectively and individually-mediate racialized health inequities among a sample of older adults from the Health and Retirement Study. Our results yield theoretical contributions by showing how the socioeconomic status-health gradient and stress processes are racialized (24% of associations examined varied by race), substantive contributions by quantifying the extent of moderated mediation of racial inequities (approximately 70%) and the relative importance of various social factors, and methodological contributions by showing how commonly used simple mediation approaches that ignore racialized moderation processes overestimate-by between 5% and 30%-the collective roles of socioeconomic status and stressors in accounting for racial inequities in health.
种族主义通过塑造关键健康社会决定因素（如社会经济资源和压力源暴露）的不平等分布，导致人口健康不平等。关于种族、社会经济资源、压力源和健康之间相互关系的研究沿着两条主线进行，这两条主线在很大程度上是分开的：一条是研究社会经济资源和压力源对不同种族群体健康的差异影响（调节过程），另一条是研究社会经济资源和压力源在导致健康方面的种族不平等中的作用（中介过程）。我们使用种族理论和一种新颖的调节中介路径分析方法，从理论和分析上整合了这些领域，以正式量化一系列社会经济资源和压力源在健康和退休研究中一组老年样本中的种族化健康不平等中的综合和单独中介作用。我们的结果通过显示社会经济地位-健康梯度和压力过程是如何种族化的（所检查的关联中有 24%因种族而异）做出了理论贡献，通过量化种族不平等的调节中介的程度（约 70%）和各种社会因素的相对重要性做出了实质性贡献，以及通过显示常见的简单中介方法如何忽略种族化的调节过程，高估了社会经济地位和压力源在解释健康方面的种族不平等的集体作用（在 5%到 30%之间），从而做出了方法学贡献。
