The operationalization of race and ethnicity concepts in medical classification systems: issues of validity and utility

This article looks at the operationalization of race and ethnicity concepts in medical classification systems, notably the main bibliographical databases of MEDLINE and EMBASE. In particular, an attempt is made to assess recent changes, including the impact of the 2004 major changes to the MeSH headings for race and ethnic groups, and the introduction of 'Continental Population Groups'. The underlying conceptual basis of the typologies, their relevance for capturing specific population groups, and their overall usefulness in appraising the literature on ethnic/racial disparities in health are examined. The bibliographical database thesauri reveal the pervasiveness of the notion of the biological basis of health differences by race/ethnicity as well as continuing use of antiquated racial terminology. Their system-oriented terminology is likely to limit the effectiveness of retrieval by users who may lack knowledge of their hierarchical structures.