Jaehn Philipp, Rach Stefan, Bolte Gabriele, Mikolajczyk Rafael, Merz Sibille, Herrera-Espejel Paula Sofia, Brand Tilman, Führer Amand, Berger Klaus, Teismann Henning, Bohn Barbara, Koch-Gallenkamp Lena, Brenner Hermann, Klett-Tammen Carolina J, Castell Stefanie, Ebert Nina, Emmel Carina, Schmidt Börge, Gastell Sylvia, Schulze Matthias B, Obi Nadia, Harth Volker, Holleczek Bernd, Jaskulski Stefanie, Katzke Verena, Kaaks Rudolf, Willich Stefan N, Keil Thomas, Weber Andrea, Leitzmann Michael, Wirkner Kerstin, Meinke-Franze Claudia, Schipf Sabine, Schikowski Tamara, Schneider Alexandra, Slesinski S Claire, Moreno-Velásquez Ilais, Pischon Tobias, Holmberg Christine
Institute of Social Medicine and Epidemiology, Brandenburg Medical School Theodor Fontane, Hochstraße 15, Brandenburg an der Havel, 14770, Germany.
Faculty of Health Sciences Brandenburg, Brandenburg Medical School Theodor Fontane, Potsdam, Germany.
Int J Equity Health. 2025 May 26;24(1):151. doi: 10.1186/s12939-025-02521-3.
Intersectionality has contributed to novel insights in epidemiology. However, participants of epidemiological studies have rarely been characterised from an intersectional perspective. We aimed to show the gained insights of an intersectionality-informed approach to describing a study population by comparing it to a conventional approach.
We used data of the German National Cohort (NAKO), which recruited 205,415 participants between 2014 and 2019. In the conventional approach, marginal proportions of educational level, cohabitation status, and country of birth were compared between the study populations of the NAKO and the German census survey (MZ) of 2014. In the intersectionality-informed approach, so-called intersectional population strata were constructed by cross-classifying educational level, cohabitation status, and country of birth. Proportions of these strata were also compared between NAKO and MZ. All analyses were stratified by sex and age group.
The conventional approach showed that the proportion of people with low education was lower in the NAKO compared to the MZ in all sex and age strata. Similarly, proportions of all intersectional population strata with low education were lower in the NAKO. Concerning cohabitation, the conventional approach showed that the proportion of those living without a partner was lower in the NAKO than in the MZ for women under 60 and men. The intersectionality-informed approach revealed that the proportions of some subgroups of those living without a partner were higher in the NAKO than in the MZ. These were intersectional population strata who lived without a partner, had a high level of education and were born in Germany. The intersectionality-informed approach revealed similar within-group heterogeneity for country of birth, showing that not all proportions of foreign-born people were lower in the NAKO compared to the MZ. Proportions of foreign-born with high education who lived with a partner were higher.
Our results showed that heterogeneity within social categories can be revealed by applying the concept of intersectionality when comparing study participants with an external population. This way, an intersectionality-informed approach contributes to describing social complexity among study participants more precisely. Furthermore, results can be used to reduce participation barriers in a more targeted way.
交叉性理论为流行病学带来了新的见解。然而，流行病学研究的参与者很少从交叉性视角进行特征描述。我们旨在通过将基于交叉性理论的方法与传统方法进行比较，展示其在描述研究人群方面所获得的见解。
我们使用了德国国民队列（NAKO）的数据，该队列在2014年至2019年间招募了205,415名参与者。在传统方法中，比较了NAKO研究人群与2014年德国人口普查调查（MZ）中教育水平、同居状况和出生国家的边缘比例。在基于交叉性理论的方法中，通过对教育水平、同居状况和出生国家进行交叉分类，构建了所谓的交叉性人群分层。还比较了NAKO和MZ之间这些分层的比例。所有分析均按性别和年龄组进行分层。
传统方法表明在所有性别和年龄分层中，NAKO中低教育程度人群的比例低于MZ。同样，NAKO中所有低教育程度的交叉性人群分层的比例也较低。关于同居情况，传统方法显示在60岁以下女性和男性中，NAKO中无伴侣生活的人群比例低于MZ。基于交叉性理论的方法表明，NAKO中一些无伴侣生活的亚组人群比例高于MZ。这些是无伴侣生活、教育水平高且出生在德国的交叉性人群分层。基于交叉性理论的方法揭示了出生国家在组内也存在类似的异质性，表明并非所有NAKO中外国出生人群的比例都低于MZ。有高学历且有伴侣生活的外国出生人群比例更高。
我们的结果表明，在将研究参与者与外部人群进行比较时，应用交叉性概念可以揭示社会类别中的异质性。通过这种方式，基于交叉性理论的方法有助于更精确地描述研究参与者之间的社会复杂性。此外，研究结果可用于更有针对性地减少参与障碍。
