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

Citation

Graetz, Nick; Boen, Courtney E.; & Esposito, Michael H. (2022). Structural Racism and Quantitative Causal Inference: A Life Course Mediation Framework for Decomposing Racial Health Disparities. Journal of Health and Social Behavior.

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.

URL

https://doi.org/10.1177/00221465211066108

Keyword(s)

g-computation

Reference Type

Journal Article

Journal Title

Journal of Health and Social Behavior

Author(s)

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

Year Published

2022

DOI

10.1177/00221465211066108

Reference ID

9526