Commentary: considerations for use of racial/ethnic classification in etiologic research.

Numerous authors have critiqued the use of race as an etiologic quantity in medical research. Despite this criticism, the use of variables encoding racial/ethnic categorization has increased in epidemiology, and most researchers agree that important variation in disease risk is captured by this classification system. Previous discussions have generally neglected to articulate guidelines for appropriate use of racial/ethnic information in etiologic research. The authors summarize the logical, conceptual, and practical problems associated with the "ethnic paradigm" as currently applied in biomedical sciences and offer a set of methodological recommendations toward more valid use of racial/ethnic classification in etiologic studies. These suggested guidelines address issues of variable definition, study design, and covariate control, providing a consistent foundation for etiologic research programs that neither ignore racial/ethnic disease disparities nor obfuscate the nature of these disparities through inappropriate analytical approaches. This methodological analysis of racial/ethnic classification as an epidemiologic quantity provides a formal basis for a focus on racism (i.e., social relations) rather than race (i.e., innate biologic predisposition) in the interpretation of racial/ethnic "effects."

[1]  J Hodgdon,et al.  Race and ethnic standards for Federal statistics and administrative reporting. , 1977, Statistical Reporter / Office Of Federal Statistical Policy And Standards.

[2]  P. Rosenbaum The Consequences of Adjustment for a Concomitant Variable that Has Been Affected by the Treatment , 1984 .

[3]  R. Cooper A note on the biologic concept of race and its application in epidemiologic research. , 1984, American heart journal.

[4]  R. David,et al.  The biological concept of race and its application to public health and epidemiology. , 1986, Journal of health politics, policy and law.

[5]  P. Holland Statistics and Causal Inference , 1985 .

[6]  P. Holland CAUSAL INFERENCE, PATH ANALYSIS AND RECURSIVE STRUCTURAL EQUATIONS MODELS , 1988 .

[7]  M. Loring,et al.  Gender, race, and DSM-III: a study of the objectivity of psychiatric diagnostic behavior. , 1988, Journal of health and social behavior.

[8]  Arthur P. Dempster,et al.  Employment Discrimination and Statistical Science , 1988 .

[9]  D. Stroup,et al.  The reporting of race and ethnicity in the National Notifiable Diseases Surveillance System. , 1989, Public health reports.

[10]  D. Beevers,et al.  Ethnic Factors in Health and Disease , 1990 .

[11]  T. Laveist,et al.  "Race" in the epidemiologic literature: an examination of the American Journal of Epidemiology, 1921-1990. , 1991, American journal of epidemiology.

[12]  D. Crews,et al.  Ethnicity as a taxonomic tool in biomedical and biosocial research. , 1991, Ethnicity & disease.

[13]  A review of the evidence for our African origins. , 1991 .

[14]  A review of the evidence for our African origins. , 1991, Ethnicity & disease.

[15]  N. Sauer,et al.  THE CONCEPT OF RACE : IF RACES DON ’ T EXIST , WHY ARE FORENSIC ANTHROPOLOGISTS SO GOOD AT IDENTIFYING THEM ? , 2002 .

[16]  J. Robins,et al.  Identifiability and Exchangeability for Direct and Indirect Effects , 1992, Epidemiology.

[17]  R. A. Stone The Assumptions on Which Causal Inferences Rest , 1993 .

[18]  R. Cooper,et al.  Health and the social status of blacks in the United States. , 1993, Annals of epidemiology.

[19]  David Theo Goldberg,et al.  Racist Culture: Philosophy and the Politics of Meaning , 1993 .

[20]  McKenney Nr,et al.  Issues regarding data on race and ethnicity: the Census Bureau experience. , 1994 .

[21]  C. Bennett,et al.  Issues regarding data on race and ethnicity: the Census Bureau experience. , 1994, Public health reports.

[22]  T. Laveist Beyond dummy variables and sample selection: what health services researchers ought to know about race as a variable. , 1994, Health services research.

[23]  Clifford C. Clogg,et al.  Handbook of statistical modeling for the social and behavioral sciences , 1995 .

[24]  Bruce G. Link,et al.  Social conditions as fundamental causes of disease. , 1995, Journal of health and social behavior.

[25]  M. Sobel Causal Inference in the Social and Behavioral Sciences , 1995 .

[26]  R Witzig,et al.  The Medicalization of Race: Scientific Legitimization of a Flawed Social Construct , 1996, Annals of Internal Medicine.

[27]  C. Muntaner,et al.  The Bell Curve: on race, social class, and epidemiologic research. , 1996, American journal of epidemiology.

[28]  G. King Institutional racism and the medical/health complex: a conceptual analysis. , 1996, Ethnicity & disease.

[29]  H. Aa Toward a conceptualization of race in epidemiologic research. , 1996 .

[30]  Describing race, ethnicity, and culture in medical research , 1996 .

[31]  L. Ahdieh,et al.  Use of the terms 'race', 'ethnicity', and 'national origins': a review of articles in the American Journal of Public Health, 1980-1989. , 1996, Ethnicity & health.

[32]  David R. Williams Race/Ethnicity and Socioeconomic Status: Measurement and Methodological Issues , 1996, International journal of health services : planning, administration, evaluation.

[33]  Toward a conceptualization of race in epidemiologic research. , 1996, Ethnicity & disease.

[34]  H. Morgenstern Defining and explaining race effects. , 1997, Epidemiology.

[35]  D. Williams,et al.  Race and health: basic questions, emerging directions. , 1997, Annals of epidemiology.

[36]  L. Jin,et al.  Ethnic-affiliation estimation by use of population-specific DNA markers. , 1997, American journal of human genetics.

[37]  R. Cooper,et al.  Socioeconomic Status and Health in Blacks and Whites: The Problem of Residual Confounding and the Resiliency of Race , 1997, Epidemiology.

[38]  E. Liu The uncoupling of race and cancer genetics , 1998 .

[39]  G. Smith,et al.  Mortality differences between black and white men in the USA: contribution of income and other risk factors among men screened for the MRFIT , 1998, The Lancet.

[40]  H. Kraemer,et al.  Ethnic and socioeconomic differences in cardiovascular disease risk factors: findings for women from the Third National Health and Nutrition Examination Survey, 1988-1994. , 1998, JAMA.

[41]  What are the underlying sources of racial differences in health? , 1998, Annals of epidemiology.

[42]  M. Cartmill,et al.  The Status of the Race Concept in Physical Anthropology , 1998 .

[43]  D. Allison,et al.  Estimating African American admixture proportions by use of population-specific alleles. , 1998, American journal of human genetics.

[44]  J. Kaufman How inconsistencies in racial classification demystify the race construct in public health statistics. , 1999, Epidemiology.

[45]  D. Ng-Mak,et al.  A further analysis of race differences in the National Longitudinal Mortality Study. , 1999, American journal of public health.

[46]  Palmer Encyclopedia of biostatistics , 1999, BMJ.

[47]  H. Kraemer,et al.  Ethnic and Socioeconomic Differences in Cardiovascular Disease Risk Factors: Findings for Women From the Third National Health and Nutrition Examination Survey, 1988-1994 , 1999 .

[48]  J. Pearl,et al.  Confounding and Collapsibility in Causal Inference , 1999 .

[49]  P. Stolley,et al.  Race in Epidemiology , 1999, International journal of health services : planning, administration, evaluation.

[50]  R. Cooper,et al.  Seeking causal explanations in social epidemiology. , 1999, American journal of epidemiology.

[51]  M. Casper,et al.  Evidence of increasing coronary heart disease mortality among black men of lower social class. , 1999, Annals of epidemiology.

[52]  C. Muntaner Invited commentary: social mechanisms, race, and social epidemiology. , 1999, American journal of epidemiology.

[53]  K A Schulman,et al.  The effect of race and sex on physicians' recommendations for cardiac catheterization. , 1999, The New England journal of medicine.

[54]  J. Robins,et al.  Marginal Structural Models and Causal Inference in Epidemiology , 2000, Epidemiology.

[55]  Peter Neufeld,et al.  Actual Innocence : Five Days to Execution and Other Dispatches from the Wrongly Convicted , 2000 .

[56]  B. Hanusa,et al.  Understanding racial variation in the use of coronary revascularization procedures: the role of clinical factors. , 2000, Archives of internal medicine.

[57]  K. Weinfurt,et al.  The effects of patient sex and race on medical students' ratings of quality of life. , 2000, The American journal of medicine.

[58]  J. Pearl Causality: Models, Reasoning and Inference , 2000 .

[59]  A. Folsom,et al.  Incident type 2 diabetes mellitus in African American and white adults: the Atherosclerosis Risk in Communities Study. , 2000, JAMA.

[60]  E. Ford Serum copper concentration and coronary heart disease among US adults. , 2000, American journal of epidemiology.

[61]  A. Whittemore,et al.  Differences in socioeconomic status and survival among white and black men with prostate cancer. , 2000, American journal of epidemiology.

[62]  K. Fiscella,et al.  Inequality in quality: addressing socioeconomic, racial, and ethnic disparities in health care. , 2000, JAMA.

[63]  M. van Ryn,et al.  The effect of patient race and socio-economic status on physicians' perceptions of patients. , 2000, Social science & medicine.