Race, Ethnicity, and Socioeconomic Status in Research on Child Health

Abstract

An extensive literature documents the existence of pervasive and persistent child health, development, and health care disparities by race, ethnicity, and socioeconomic status (SES). Disparities experienced during childhood can result in a wide variety of health and health care outcomes, including adult morbidity and mortality, indicating that it is crucial to examine the influence of disparities across the life course. Studies often collect data on the race, ethnicity, and SES of research participants to be used as covariates or explanatory factors. In the past, these variables have often been assumed to exert their effects through individual or genetically determined biologic mechanisms. However, it is now widely accepted that these variables have important social dimensions that influence health. SES, a multidimensional construct, interacts with and confounds analyses of race and ethnicity. Because SES, race, and ethnicity are often difficult to measure accurately, leading to the potential for misattribution of causality, thoughtful consideration should be given to appropriate measurement, analysis, and interpretation of such factors. Scientists who study child and adolescent health and development should understand the multiple measures used to assess race, ethnicity, and SES, including their validity and shortcomings and potential confounding of race and ethnicity with SES. The American Academy of Pediatrics (AAP) recommends that research on eliminating health and health care disparities related to race, ethnicity, and SES be a priority. Data on race, ethnicity, and SES should be collected in research on child health to improve their definitions and increase understanding of how these factors and their complex interrelationships affect child health. Furthermore, the AAP believes that researchers should consider both biological and social mechanisms of action of race, ethnicity, and SES as they relate to the aims and hypothesis of the specific area of investigation. It is important to measure these variables, but it is not sufficient to use these variables alone as explanatory for differences in disease, morbidity, and outcomes without attention to the social and biologic influences they have on health throughout the life course. The AAP recommends more research, both in the United States and internationally, on measures of race, ethnicity, and SES and how these complex constructs affect health care and health outcomes throughout the life course.

Developmental Trajectories of Subjective Social Status

“…Furthermore, research studies of adolescent health frequently obtain waivers of parental consent and/or do not collect information directly from parents. Thus, despite the recognized need to incorporate social determinants of health into adolescent health research studies, 36 SES data are frequently either lacking or inaccurate. Our findings suggest that adolescents' SSS, which is easily obtained with the single-item ladder question, can both serve as a marker of family SES and provide information on the subjective dimension of social status.…”

Investigating the psychosocial determinants of child health in Africa: The Drakenstein Child Health Study

“…Race classification was historically required under the apartheid system in South Africa. While we do not intend to reify these categories, information on population group is collected in this study, as persistent health disparities exist across groups in South Africa, and disparities in child health and development related to ethnicity and SES are well-documented worldwide (Cheng and Goodman, 2015). …”

Community Poverty and Child Abuse Fatalities in the United States

“…16 As government and child protective agencies strive to target high-risk communities for preventive interventions and resources, understanding community poverty concentration as a risk factor for fatal abuse is critical. 17 Our objective was to analyze the association between community poverty concentration and child abuse fatality rates, and we hypothesized a positive association between county-level poverty concentration and rates of fatal abuse.…”