Recommendations for Using Causal Diagrams to Study Racial Health Disparities

Chanelle J. Howe, Zinzi D. Bailey, Julia R. Raifman, John W. Jackson

Research output: Contribution to journalReview articlepeer-review

33 Scopus citations


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.

Original languageEnglish (US)
Pages (from-to)1981-1989
Number of pages9
JournalAmerican journal of epidemiology
Issue number12
StatePublished - Dec 1 2022
Externally publishedYes

Bibliographical note

Publisher Copyright:
© The Author(s) 2022. Published by Oxford University Press on behalf of the Johns Hopkins Bloomberg School of Public Health. All rights reserved.


  • epidemiologic methods
  • health status disparities
  • race relations
  • racism


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