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

Area of Science:

• Social Epidemiology
• Health Disparities Research
• Quantitative Social Sciences

Background:

• Traditional studies of racial health disparities often rely on static race measures, which conflict with social theories of race and racism.
• Existing methods may not fully capture the dynamic, systemic nature of how race and racism influence health outcomes over time.

Purpose of the Study:

• To propose and demonstrate a counterfactual framework for analyzing dynamic racial health inequities.
• To operationalize 'race' as a social process shaped by racism, rather than a fixed individual characteristic.
• To decompose racial disparities in cardiometabolic risk into distinct components attributable to racism.

Main Methods:

• Utilized a counterfactual approach to model time-varying confounding and mediation.
• Examined racial inequities in cardiometabolic risk using data from the National Longitudinal Study of Adolescent to Adult Health.
• Decomposed observed disparities into controlled direct effects (unobserved racism), interaction effects (racial discrimination), and pure indirect effects (emergent discrimination).

Main Results:

• The study demonstrates a novel method to quantify the dynamic influence of racism on health disparities.
• The framework allows for the decomposition of racial inequities into specific types of discriminatory effects.
• Findings highlight the complex interplay of systemic factors in producing racial health inequities.

Conclusions:

• Counterfactual approaches, when combined with critical theories, offer a powerful tool for quantifying the impact of interlocking systems on racial health inequities.
• This framework moves beyond static measures to capture the dynamic nature of race and racism in health research.
• The study provides a quantitative method to understand how racism, racial discrimination, and emergent discrimination contribute to health disparities.