1. Give an example of a research question for investigating racial/ethnic health disparities where: [1] SES is a confounder; [2] SES is an effect modifier; [3] SES is a mediator. Briefly discuss the interpretations/implications of each approach as it relates to understanding health disparities by race/ethnicity.
Tubal factor infertility disproportionately affects women of color. (Exposure: women of color, Outcome: tubal factor infertility)
SES is a confounder – here SES can serve as a confounder as women of color are less likely to generate similar earnings as their white male counterparts even after equivalency in education attainment is established and being of lower SES is a direct predictor of tubal factor infertility.
SES is an effect modifier – while Black and Hispanic women are at greater risk of acquiring a STI, SES serves as an effect modifier as racial/ethnic disparities in STI acquirement are less pronounced among those with higher SES compared to those with lower SES.
SES is a mediator – women with low SES are more likely to lack access to insurance therefore, they are more likely to forego surgeries to treat tubal factor infertility secondary to hydrosalpinges and are therefore more likely to have worse outcomes if they do pursue fertility treatment.
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.
Uterine factor infertility, namely fibroids, disproportionately affects Black women, however, studies have not been able to determine how beneficial conservative vs surgical management is in restoring anatomy and promoting fertility in this population. We know surgical resection of submucosal myomas in prudent prior to an embryo transfer but the data is controversial for asymptomatic intramural myomas especially those with almost no invasion into the endometrium irrespective a size. I would be interested in determining whether myomectomy for an intramural myoma without a submucosal component has a differential effect on fertility outcomes by race/ethnicity. While I do not feel as though there is a biologic component to myomas as they can affect all populations, the quoted fibroid component in uterine factor has been used to explain disparities in infertility among Black women, thus I would want to see if outcomes of management of asymptomatic intramural myomas differ based on race/ethnicity. Here, race/ethnicity would serve as an effect modifier.
3. Respond to one other person's post on the forum with a comment or suggestion.
Please see response to Michelle Lee.