Methodological Approaches to Understanding Causes of Health Disparities

Publisher: American Journal of Public Health, vol. 109, issue s1
Jan 30, 2019
Neal Jeffries, Alan M. Zaslavsky, Ana V. Diez Roux, John W. Creswell, Richard C. Palmer, Steven E. Gregorich, James D. Reschovsky, Barry I. Graubard, Kelvin Choi, Ruth M. Pfeiffer, Xinzhi Zhang, and Nancy Breen

Understanding health disparity causes is an important first step toward developing policies or interventions to eliminate disparities, but their nature makes identifying and addressing their causes challenging.

Potential causal factors are often correlated, making it difficult to distinguish their effects. These factors may exist at different organizational levels (e.g., individual, family, neighborhood), each of which needs to be appropriately conceptualized and measured. The processes that generate health disparities may include complex relationships with feedback loops and dynamic properties that traditional statistical models represent poorly.

Because of this complexity, identifying disparities’ causes and remedies requires integrating findings from multiple methodologies. We highlight analytic methods and designs, multilevel approaches, complex systems modeling techniques, and qualitative methods that should be more broadly employed and adapted to advance health disparities research and identify approaches to mitigate them.