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.
How does Medicaid impact inpatient mortality from sepsis? Here SES is a confounder as it relates to both variables.
How does homelessness impact inpatient mortality from sepsis? Here SES is an effect modifier because it can help explain the strength of the relationship.
Is there an association between limited english proficiency and 7 day readmission? Here SES is a mediator that can help explain the causal pathway of the relationship, ie including SES better captures the reason for readmission after discharge than LEP status.
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.
I am interested in exploring the relationship between 7 day readmission and self-identified race/ethnicity in hospital medicine patients. Patient's language/Limited English Proficiency status is an important variable to consider. This may be a mediator or an effect modifier. To figure this out, I built a model exploring the relationship between just 7 day readmission and race/ethnicity, 7 day readmission and just language, then a model with all three, and finally a larger model with additional variables. By looking at the effect size/OR, the relationship could be explored.