Racialized Health Inequities: Quantifying Socioeconomic and Stress Pathways Using Moderated Mediation.

Area of Science:

• Social Epidemiology
• Health Disparities Research
• Race and Health Studies

Background:

• Racism shapes unequal distribution of social determinants of health (SDOH), like socioeconomic resources and stressors.
• Research on race, SDOH, and health has largely focused on either moderation or mediation, remaining separate.
• Integrating these approaches is crucial for understanding complex pathways to health inequities.

Purpose of the Study:

• To conceptually and analytically integrate moderation and mediation processes in race and health research.
• To quantify the extent to which socioeconomic resources and stressors mediate racialized health inequities.
• To apply a novel moderated mediation approach using race theory.

Main Methods:

• Utilized a moderated mediation approach to path analysis.
• Analyzed data from a sample of older adults from the Health and Retirement Study.
• Examined the interplay of race, socioeconomic resources, stressors, and health outcomes.

Main Results:

• Demonstrated that the socioeconomic status-health gradient and stress processes are racialized, with 24% of associations varying by race.
• Quantified moderated mediation of racial inequities, accounting for approximately 70% of the effect.
• Identified the relative importance of various social factors in driving health disparities.

Conclusions:

• The study provides theoretical insights into how SDOH and stress processes are racialized.
• Offers substantive quantification of moderated mediation in racial health inequities.
• Highlights methodological limitations of simple mediation approaches that ignore racialized moderation, leading to overestimation of effects.