Health experiences and inequalities across intersecting social identities in health research: a scoping review

Intersectionality provides a framework to help enable critical thinking about how sociodemographic factors interact. There is currently limited evidence on whether the overlap of multiple sociodemographic identities, typically associated with underrepresentation and being underserved in research (eg, minority ethnicity, lower socioeconomic status (SES)), affects health conditions and outcomes. Given the essential role that clinical trials have in the development of effective treatments, this makes it challenging to address whether intersectionality should be considered in trials. This scoping review aimed to map the existing literature on the impact of intersectionality on health experiences and inequalities in developed economies, and identify whether or not the overlap of two or more sociodemographic factors (eg, race/ethnicity and sex/gender and/or SES), is associated with poorer health.

Following the Arksey and O'Malley Framework and Joanna Briggs Institute methodology, the review adhered to Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews guidelines. Databases searched included Medline, Embase, Web of Science, International Bibliography of the Social Sciences, and Sociological Abstracts. Selection criteria were based on the Population-Concept-Context mnemonic, targeting studies that explicitly referenced intersecting sociodemographic factors and their impact on health experiences. Data were extracted from the Discussions section of the included studies, specifically any reports of the effects of intersectional sociodemographic factors, such as ethnicity, sex, gender, and SES, on health conditions and outcomes.

Thirty-three studies met the inclusion criteria. The review found that people who belong to more than one sociodemographic group typically underserved in research (eg, minoritized ethnic and experience of socioeconomic disadvantage) tend to have poorer health. This review also found that context is an important component, with some traditionally more privileged groups (eg, White, male, and with a high socioeconomic background) having relatively poorer health outcomes depending on the context.

Overall, holding intersectional underserved identities is likely to lead to poorer health; however, there is no simple relationship, and context plays a role. These findings emphasize the need for inclusive clinical trials that account for intersectionality and the necessity of designing inclusive research that reflects diverse populations.