Despite repeated calls by scholars to critically engage with the concepts of race and ethnicity in US epidemiologic research, the incorporation of these social constructs in scholarship may be suboptimal. This study characterizes the conceptualization, operationalization, and utilization of race and ethnicity in US research published in leading journals whose publications shape discourse and norms around race, ethnicity, and health within the field of epidemiology. We systematically reviewed randomly selected articles from prominent epidemiology journals across five periods: 1995-99, 2000-04, 2005-09, 2010-14, 2015-18. All original human-subjects research conducted in the US was eligible for review. Information on definitions, measurement, coding, and use in analysis was extracted. We reviewed 1050 articles, including 414 (39%) in analyses. Four studies explicitly defined race and/or ethnicity. Authors rarely made clear delineations between race and ethnicity, often adopting an ethno-racial construct. In the majority of studies across time periods, authors did not state how race and/or ethnicity was measured. Top coding schemes included “Black, White” (race), “Hispanic, Non-Hispanic” (ethnicity), and “Black, White, Hispanic” (ethno-racial). Most often, race and ethnicity were deemed “not of interest” in analyses (e.g., control variable). Broadly, disciplinary practices have remained largely the same between 1995-2018 and are in need of improvement.

Allostatic load refers to wear and tear on the body due to repeated activation of the stress response and, thus, may be an early subclinical indicator of future disease and mortality risk. To date, few studies of allostatic load have focused on young adults, racial/ethnic comparisons that include Mexican Americans, or the interplay between race/ethnicity, gender, and educational attainment. To fill these gaps, we used data on non-Hispanic Black, non-Hispanic White, and Mexican-origin respondents from Waves I (1994–1995) and IV (2007–2008) of the National Longitudinal Study of Adolescent to Adult Health (Add Health; N = 11,807). We calculated allostatic load scores based on respondents’ values for 10 metabolic, cardiovascular, and inflammatory biomarkers measured at Wave IV, when respondents were 24–34 years old. We then used negative binomial regression models to assess the combined effects of race/ethnicity, gender, and educational attainment on allostatic load, while controlling for key covariates. We found that Black women had significantly higher allostatic load scores than White women and Black men, net of educational attainment and other covariates. Yet, education modified the relationship between race/ethnicity, gender, and allostatic load. Obtaining a college education was protective for White males and females but no more or less protective for other women and deleterious for Black males. In other words, by the time they reach young adulthood, the cumulative physiological burden of stress on Black women and college-educated Black men is already greater than it is among their similarly or less educated White counterparts. These findings provide important information about the intermediate physiological dysregulation that underlies social inequalities in stress-related health outcomes, especially those that occur at the intersections of race/ethnicity, gender, and educational attainment. They also suggest that research on its antecedents should focus on earlier life periods.

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BackgroundSystemic racial and ethnic inequities continue to be perpetuated through scientific methodology and communication norms despite efforts by medical institutions. We characterized methodological practices regarding race and ethnicity in U.S. research published in leading medical journals.MethodsWe systematically reviewed randomly selected articles from prominent medical journals: Annals of Internal Medicine, BMJ, JAMA, The Lancet, and NEJM within five periods: 1995-99, 2000-04, 2005-09, 2010-14, 2015-18. Original human-subjects research conducted in the U.S. was eligible for inclusion. We extracted information on definitions (conceptualization), measurement/coding (operationalization), use in analysis (utilization), and justifications. We reviewed 1050, including 242 (23%) in analyses.FindingsThe proportion of U.S. medical research studies including race and/or ethnicity data increased between 1995 and 2018. However, no studies defined race or ethnicity. Studies rarely delineated between race and ethnicity, frequently opting for a combined “ethno-racial” construct. In addition, most studies did not state how race and/or ethnicity was measured. Common coding schemes included: “Black, other, White,” “Hispanic, Non-Hispanic,” and “Black, Hispanic, other, White.” Race and/or ethnicity was most often used as a control variable, descriptive covariate, or matching criteria. Under 30% of studies included a justification for their methodological choices regarding race and/or ethnicity.InterpretationDespite regular efforts by medical journals to implement new policies around race and ethnicity in medical research, pertinent information around methodology was systematically absent from the majority of reviewed literature. This stymies critical disciplinary reflection and progress towards equitable practice.FundingFunding was provided through training grants from the Eunice Kennedy Shriver National Institute of Child Health and Human Development [T32 HD091058] and the Department of Sociology, UNC Chapel Hill. Carolina Population Center provided general support [P2C HD050924, P30 AG066615]. NRS received additional support from the National Cancer Institute [T32 CA057711].