Conceptualization, operationalization, and utilization of race and ethnicity in major medical journals 1995-2018: a systematic review

Abstract

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].

Misracialization of Indigenous people in population health and mortality studies: a scoping review to establish promising practices

“…The biomedical sciences have already been criticized for this practice, which leads to over-reliance on genetic explanations for racial differences. 16 , 32 – 34 …”

Evaluating equity in performance of an electronic health record-based 6-month mortality risk model to trigger palliative care consultation: a retrospective model validation analysis

“…Discrepancies between EHR racial categorisations and self-reported racial identity data are well-documented, with related limitations from the use of a small number of a priori categories determined by the Office of Management and Budget 41–43. Thus, we understand the patient race variable best reflects how a patient is racialised by healthcare institutions, and therefore a patient’s experience of racism, both structural and interpersonal, in healthcare delivery (patients with race coded as ‘Black or African-American’ are assumed to be racialised as black) 8 14 15 44. Similarly, given the enormous heterogeneity of people labelled as ‘Hispanic’ and the significant limitation of a single ethnic category,45 we use the ethnicity variable (‘Hispanic’ vs ‘non-Hispanic’) as distinct from race and a proxy for position within society, (eg, systematic exclusion from jobs with adequate sick leave policies) rather than sociocultural characteristics (eg, referring to a specific diet or language) 44–47…”

Racial Misclassification, Discrimination, Consciousness, and Self-Rated Health Among Native Hawaiian and Pacific Islander Adults in the USA

“…Medical researchers have historically utilized the variable of race uncritically, rarely defining it as socially constructed and often omitting information about how it was measured [1,2]. In a systematic review of articles published between 1995 and 2018 in prominent medical journals, not a single study defined race, and most did not describe how it was measured [2]. Not only does this limit the insights research can reveal, but it may also perpetuate myths of biological race and contribute to racist ideologies [3,4].…”