Structural Racism and Quantitative Causal Inference: A Life Course Mediation Framework for Decomposing Racial Health Disparities
2022/01/08 by Nick Graetz, Nicholas Graetz, Courtney E. Boen +3 · 93 citations
Health Professions · Medicine · Psychology · Social Sciences · #Artificial intelligence #Causal inference #Computer science #Econometrics #Economics #Food Security and Health in Diverse Populations #Gender studies #Health disparities and outcomes #Health equity #Inference #Life course approach #Mediation #Medicine #Psychology #Public health #Racial and Ethnic Identity Research #Racial bias #Racism #Social psychology #Social science #Sociology
paper · open access · doi:10.1177/00221465211066108
published in Journal of Health and Social Behavior 63(2), 232-249 (SAGE Publishing)
openalex publication_date 2022/01/08 · openalex created_date 2025/10/10 · openalex updated_date 2026/08/01
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.
Citations
Cited by
- Structural Racism and Health Stratification: Connecting Theory to Measurement
- Patterns and Life Course Determinants of Black–White Disparities in Biological Age Acceleration: A Decomposition Analysis
- Adverse Infant Health Outcomes Increased After the 2016 U.S. Presidential Election Among Non-White U.S.-born and Foreign-born Mothers
- Racial Capitalism and Black–White Health Inequities in the United States: The Case of the 2008 Financial Crisis
- Reexamining the causes of age patterns in Black-White birth weight disparities: Evidence from U.S. cohorts
- Uncovering Bias Paths with LLM-guided Causal Discovery: An Active Learning and Dynamic Scoring Approach
- Discrimination and Civic Engagement of Immigrants in Western Societies. A Systematic Scoping Review
- Racial Justice Beyond the Curriculum: Aligning Systems of Care With Anti-Racist Instruction in Graduate Medical Education. [europepmc]
- Institutional Racism and Health: a Framework for Conceptualization, Measurement, and Analysis. [europepmc]
- Unmet Social Health Needs as a Driver of Inequitable Outcomes After Surgery: A Cross-sectional Analysis of the National Health Interview Survey. [europepmc]
- Tools to Measure the Impact of Structural Racism and Discrimination on Gastrointestinal and Hepatology Disease Outcomes: A Scoping Review. [europepmc]
- Racial-Ethnic Disparities in Dual-Function Life Expectancy. [europepmc]
- Structural racism theory, measurement, and methods: A scoping review. [europepmc]
- Intersectionality-informed analysis of durable viral suppression disparities in people with HIV. [europepmc]
- Racialized Health Inequities: Quantifying Socioeconomic and Stress Pathways Using Moderated Mediation. [europepmc]
- Decomposing interaction and mediating effects of race/ethnicity and circulating blood levels of cystatin C on cognitive status in the United States health and retirement study. [europepmc]
- Advancing Research To Address The Health Impacts Of Structural Racism In US Immigration Prisons. [europepmc]
- COVID-19's Unequal Toll: Differences in Health-Related Quality of Life by Gendered and Racialized Groups. [europepmc]
- Patterns and Life Course Determinants of Black-White Disparities in Biological Age Acceleration: A Decomposition Analysis. [europepmc]
- Structural Racism and Health Stratification: Connecting Theory to Measurement. [europepmc]
- Methods for structural sexism and population health research: Introducing a novel analytic framework to capture life-course and intersectional effects. [europepmc]
- Assessing the Influence of Redlining on Intergenerational Wealth and Body Mass Index Through a Quasi-experimental Framework. [europepmc]
- The mediating role of systemic inflammation and moderating role of racialization in disparities in incident dementia. [europepmc]
- Racial Capitalism and Black-White Health Inequities in the United States: The Case of the 2008 Financial Crisis. [europepmc]
- Effects of an Intervention on Black Family Incomes on Self-Rated Health and Obesity in Black and White Adolescents and Young Adults. [europepmc]
- Methodological approaches to structural change: epidemiology and the case for reparations. [europepmc]
- Segregation in hospital care for Medicare beneficiaries by race and ethnicity and dual-eligible status from 2013 to 2021. [europepmc]
- How Race, Gender, and Cohort Shape Social Isolation and Loneliness in Older Americans. [europepmc]
- The development, evolution, and maintenance of structural racism for the study of health inequities: An expanded framework for Asian, Black, Hispanic, Indigenous, and White Americans. [europepmc]
- Gender and the Economic Consequences of Divorce in the United States: Variation by Race and Ethnicity. [europepmc]
- Causal Inference in Health Disparities Research. [europepmc]
Related