Please post to the forum by 1pm on the day of class
1. What are 3 different ways to account for SES in a analytic models when investigating racial/ethnic health disparities? Briefly discuss the interpretations/implications of each approach as it relates to understanding health disparities by race/ethnicity.
Control for SES—this would take out the effect of SES on racial/ethnic disparities. This is typically done when we think something is a confounder. I don’t think SES should be considered a confounder because nothing causes race.
Not control for SES—if we think SES is in part mediated by racial/ethnic disparities, it might make sense to do a mediation analysis to see if SES mediates the relationship between race and a health disparity.
Effect modification—you can also assess for effect modification and look at two variables race and SES together. This gives a sense of the intersectionality of race and SES.
2. Describe a potential effect modifier, mediator, or contextual variable (for definition of contextual variable, see Diez-Roux reading) for an association of interest to you and relevant to health disparities. For example, for investigating the association between education and hypertension, I might be interested in evaluating whether the association between years of education and hypertension is different for Black men than for White men. Describe how you would study whether this relationship exists.
If we think of racial disparities in the outcome of maternal morbidity and mortality, an example of an effect modifier might be SES. We can look at race and SES at the same time by comparing women of different races and SES. You could do this with an interaction term in the analysis or by stratification. If there does seem to be significant interaction then there is evidence of effect modification.
SES could also be a mediator. If we think that SES is a mediator of the relationship between race and maternal morbidity and mortality then we could do a mediation analysis.
Neighborhood violence may be an example of a contextual variable. This is a group-level (community level) variable that may impact the individual outcome of maternal mortality and morbidity. This could be evaluated with a multi-level analysis.
3. Respond to one other person's post on the forum with a comment or suggestion.
In response to assessing mediation between ethnicity among Guatemalan women and low birth weight infants, would you assess for mediation of the listed factors using a mediation analysis? It seems like most of these factors are individual-level.