Structural Racism and Quantitative Causal Inference: A Life Course Mediation Framework for Decomposing Racial Health Disparities

Nick Graetz, Courtney E. Boen, Michael H. Esposito

Research output: Contribution to journalArticlepeer-review

44 Scopus citations

Abstract

Quantitative studies of racial health disparities often use static measures of self-reported race and conventional regression estimators, which critics argue is inconsistent with social-constructivist theories of race, racialization, and racism. We demonstrate an alternative counterfactual approach to explain how multiple racialized systems dynamically shape health over time, examining racial inequities in cardiometabolic risk in the National Longitudinal Study of Adolescent to Adult Health. This framework accounts for the dynamics of time-varying confounding and mediation that is required in operationalizing a “race” variable as part of a social process (racism) rather than a separable, individual characteristic. We decompose the observed disparity into three types of effects: a controlled direct effect (“unobserved racism”), proportions attributable to interaction (“racial discrimination”), and pure indirect effects (“emergent discrimination”). We discuss the limitations of counterfactual approaches while highlighting how they can be combined with critical theories to quantify how interlocking systems produce racial health inequities.

Original languageEnglish (US)
Pages (from-to)232-249
Number of pages18
JournalJournal of health and social behavior
Volume63
Issue number2
DOIs
StatePublished - Jun 2022
Externally publishedYes

Bibliographical note

Funding Information:
We thank Irma Elo, Xi Song, Tukufu Zuberi, and Daniel Aldana Cohen for their helpful feedback on earlier drafts of this article. We also thank Bridget Goosby and participants of the Expanding Diversity of Biosocial Research: Opportunities and Challenges session at the 2020 meeting of the American Sociological Association. This research uses data from the National Longitudinal Study of Adolescent to Adult Health (Add Health), a program project directed by Kathleen Mullan Harris and designed by J. Richard Udry, Peter S. Bearman, and Kathleen Mullan Harris at the University of North Carolina at Chapel Hill and funded by Grant P01-HD31921 from the Eunice Kennedy Shriver National Institute of Child Health and Human Development, with cooperative funding from 23 other federal agencies and foundations. Information on how to obtain the Add Health data files is available on the Add Health website (http://www.cpc.unc.edu/addhealth). NG was supported by the Eunice Kennedy Shriver National Institute of Child Health and Human Development Training Grant (T32-HD-007242-36A1). CB is grateful to the Population Studies Center at the University of Pennsylvania (National Institutes of Health’s Eunice Kennedy Shriver National Institute of Child Health and Human Development, NIH Grant No. R24 HD044964) and the Axilrod Faculty Fellowship program at the University of Pennsylvania for general support. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Funding Information:
This research uses data from the National Longitudinal Study of Adolescent to Adult Health (Add Health), a program project directed by Kathleen Mullan Harris and designed by J. Richard Udry, Peter S. Bearman, and Kathleen Mullan Harris at the University of North Carolina at Chapel Hill and funded by Grant P01-HD31921 from the Eunice Kennedy Shriver National Institute of Child Health and Human Development, with cooperative funding from 23 other federal agencies and foundations. Information on how to obtain the Add Health data files is available on the Add Health website ( http://www.cpc.unc.edu/addhealth ). NG was supported by the Eunice Kennedy Shriver National Institute of Child Health and Human Development Training Grant (T32-HD-007242-36A1). CB is grateful to the Population Studies Center at the University of Pennsylvania (National Institutes of Health’s Eunice Kennedy Shriver National Institute of Child Health and Human Development, NIH Grant No. R24 HD044964) and the Axilrod Faculty Fellowship program at the University of Pennsylvania for general support. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Publisher Copyright:
© American Sociological Association 2022.

Keywords

  • g-computation
  • life course
  • mediation
  • racial health disparities
  • racism

PubMed: MeSH publication types

  • Journal Article
  • Research Support, N.I.H., Extramural

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