"We adjusted for race" now what: A systematic review of utilization and reporting of race in AJE and Epidemiology, 2020-2021
Abstract
Race is a social construct, commonly used in epidemiologic research to adjust for confounding. However, adjustment of race may mask racial disparities thereby perpetuating structural racism. We conducted a systematic review of articles published in Epidemiology and American Journal of Epidemiology between 2020 and 2021 to 1) understand how race, ethnicity, and similar social constructs were operationalized, utilized, and reported and 2) characterize good and poor practices of utilization and reporting of race data based on the extent to which they reveal or mask systemic racism. Original research articles were considered for full review and data extraction if race data were used in the study analysis. We extracted how race was categorized; utilized - as descriptor, confounder, or for effect measure modification (EMM); and reported - if the authors discussed racial disparities and systemic bias-related mechanisms responsible for perpetuating the disparities. Of the 561 articles, 299 had race data available and 192 (34.2%) used race data in analyses. Among the 160 United States-based studies, 81 different racial categorizations were used. Race was most often utilized as a confounder (52%), followed by effect measure modifier (33%), and descriptive variable (12%). Fewer than one in four articles (22.9%) exhibited good practices (EMM along with discussing disparities and mechanisms), 63.5% of the articles exhibited poor practices (confounding only or not discussing mechanisms), and 13.5% were considered neither poor nor good practices. We discuss implications and provide 13 recommendations for operationalization, utilization, and reporting of race in epidemiologic and public health research.
