New Directions in Analyzing Health Inequities

Proposal: Two overarching goals of the National Institute of Nursing Research’s 2022-2026 Strategic Plan are for nursing scientists to focus on “dismantling structures that perpetuate racism and impede health equity” and apply “a multi-level perspective to develop and implement interventions to address social determinants of health (SDOH) across the lifespan.” The challenge for health researchers is to create new paradigms to better capture race as a social construct and develop new approaches to determine the impact of race and its intersection with other social-ecological factors on health and well-being, with the ultimate goal of reducing health inequities. Traditionally, researchers have examined racial differences in health outcomes by including race as a proxy for racism and, sometimes, its interaction with other social factors as covariates in statistical models. This approach, however, has not greatly expanded our understanding of factors driving differential outcomes based on race. Further, such analyses often collapse race into a small set of racial/ethnic categories, limiting the understanding of inequities across marginalized identities and constraining the clinical utility of the findings. The over-reliance on these analytic approaches and statistical significance testing has limited our ability to adequately address health inequities. Thus, population health researchers, including nurses, are currently considering multi-level approaches that incorporate a comprehensive framework to identify specific racial group differences in (1) health outcome prevalence, (2) SDOH exposure prevalence, and (3) effect size. Our goal is to discuss new directions for analyzing racism as a social contributor of health that incorporate a multi-level perspective and, hopefully, lead to effective interventions to reduce racial heath inequities. We will specifically address ways in which these new approaches differ from traditional methods and identify important considerations when applying such methods. New approaches include the application of (1) structural equation models to analyze the structural relationship between observed variables and unobserved latent constructs and (2) latent class/profile/transition models that allow us to better understand the intersection of racism with other social contributors (such as sexism and homophobia) and their impact on inequitable clinical outcomes. Our presentation team is comprised of emerging nurse scientists and a senior biostatistician with clinical and research expertise in SDOH. The discussion will be tailored for health profession educators and health scientists working towards mitigating the harmful effects of structural and interpersonal racism on health.