BackgroundThe implementation of a theoretical intersectionality framework into quantitative data analyses is gaining increasing interest in health research. The substantive foundation of intersectionality was established in the U.S., based on the claim of black feminists to broaden the scope of contemporary gender studies by considering the intersection between sex/gender and race/ethnicity more firmly. The aim of our scoping review with particular emphasis on sex/gender was to assess how intersectionality-informed studies in epidemiological research considered different social dimensions in their multivariable and multivariate analyses.MethodsFollowing the PRISMA Extension for Scoping Reviews (PRISMA-ScR), we conducted a literature review in PubMed. Three distinct health-related fields were brought into focus: diabetes representing a frequent chronic disease, smoking as a wide-spread behavioural health determinant and physical activity as a central target for health promotion. Initially, we compared which and how different social dimensions were accounted for and how inter-categorical and intersectionality-informed analyses were conducted. Further, we assessed sex/gender sensitivity by comparing operationalisation of sex/gender, how sex/gender theories were used and which central theoretical sex/gender concepts were referred to when aiming at explanation of (intersectional) sex/gender differences.ResultsOur results suggest, that intersectionality-based analyses within the three selected health-related fields are mainly conducted in the U.S. and focused on the intersection between sex/gender and race/ethnicity by using them jointly as subgrouping variables and as parts of interaction terms in regression analyses. Income and education as proxies for social class as well as age are mainly used for adjustment in quantitative analyses. Other approaches for calculating interactions (i.a. synergy-index, CART-analysis) are an exception. Even though sex/gender was considered in every included study and Gender was the most frequent theoretical sex/gender concept referred to when theoretically explaining sex/gender differences, it was exclusively operationalised as binary and solution-linked sex/gender variables were hardly considered in quantitative analyses.ConclusionThe systematic integration of solution-linked variables indicating modifiable aspects of sex/gender-related living conditions and disadvantages could improve sex/gender sensitivity as part of intersectionality-based quantitative data analysis in health research.

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Implementation of an intersectionality perspective into quantitative health research might support the process of unravelling complex socio-cultural and economic power relations which underly and shape patterns of health and disease within populations. Intersectionality-informed health monitoring and health reporting integrating a sex/gender-sensitive perspective could serve as a fertile ground to strengthen the essential function of health reporting to support political decision-making. We aimed at the integration of social theory into quantitative data analysis by taking into consideration 4 distinct central sex/gender theoretical concepts in health research. We developed and tested an intersectionality-based, sex/gender-sensitive strategy comparing 5 distinct models based on different combinations of the binary sex/gender variable, socio-cultural and economic variables (defined from an intersectionality perspective) as well as solution-linked sex/gender variables. We used CART-analysis as a quantitative, non-parametric, exploratory method to detect subgroups with high prevalence of frequent mental distress (FMD). Analyses were based on data from a National Health Telephone Interview Survey conducted in Germany. Depending on model and detected subgroup of our comparative approach, prevalence of FMD ranged between approximately 5 %–25%. Within the model including the binary sex/gender variable, socio-cultural and economic variables, sex/gender turned out to be the most important attribute. Comparing the models which included solution-linked sex/gender variables to the model not including these variables illustrated that the CART-algorithm was able to detect subgroups with the same prevalence of FMD, but with approximately 14% as opposed to 4.5% of the study population being affected. For these models, social support served as the primary splitting variable and not the binary sex/gender variable. Including or not including the binary sex/gender variable in the models with the solution-linked variables did not make a substantial difference. Embedding CART-analysis in social theory might have the potential to further sex/gender sensitivity in health reporting and might support decision-making when considering the allocation of health-related interventions.

Representativeness has been defined as the degree of similarity of a study population compared to an external population. To characterize a study population, both health-related and social or demographic features should be considered according to current guidelines. However, little guidance is given on how to describe social complexity of study populations when aiming to conclude on representativeness. We argue that sociological concepts should inform characterizations of study populations in order to increase credibility of conclusions on representativeness. The concept of intersectionality suggests to conceptualize social location as a combination of characteristics such as sex/gender and ethnicity instead of focusing on each feature independently. To contextualize advantages of integrating the concept of intersectionality when investigating representativeness, we reviewed publications that described the baseline population of selected epidemiological cohort studies. Information on the applied methods to characterize the study population was extracted, as well as reported social characteristics. Nearly all reviewed studies reported descriptive statistics of the baseline population and response proportions. In most publications, study populations were characterized according to place of residence, age and sex/gender while other social characteristics were reported irregularly. Differential patterns of representativeness were revealed in analyses that stratified social characteristics by sex/gender or age. Furthermore, the included studies did not explicitly state the theoretical approach that underlay their description of the study population. Intersectionality might be particularly fruitful when applied to descriptions of representativeness, because this concept provides an understanding of social location that has been developed based on situated experiences of people at the intersection of multiple axes of social power relations. An intersectional perspective, hence, contributes to approximate social complexity of study populations and might contribute to increase validity of conclusions on representativeness of population-based studies.

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