Given the diversity of sex, gender identity, race, ethnicity, and socioeconomic position (SEP) in children across the United States, it is incumbent upon pediatric and epidemiologic researchers to conduct their work in ways that promote inclusivity, understanding and reduction in inequities. Current child health research often utilizes an approach of “convenience” in how data related to these constructs are collected, categorized, and included in models; the field needs to be more systematic and thoughtful in its approach to understand how sociodemographics affect child health. We offer suggestions for improving the discourse around sex, gender identity, race, ethnicity, and SEP in child health research. We explain how analytic models should be driven by a conceptual framework grounding the choices of variables that are included in analyses, without the automatic “adjusting for” all sociodemographic constructs. We propose to leverage newly available data from large multi-cohort consortia as unique opportunities to improve the current standards for analyzing and reporting core sociodemographic constructs. Improving the characterization and interpretation of child health studies with regards to core sociodemographic constructs is critical for optimizing child health and reducing inequities in the health and well-being of all children across the United States.
Current child health research often utilizes an approach of “convenience” in how data related to sex, race/ethnicity, and SEP are collected, categorized, and included in models.
We offer suggestions for how scholars can improve the discourse around sex, gender identity, race, ethnicity, and SEP in child health research.
We explain how analytic models should be driven by a conceptual framework grounding the choices of variables that are included in analyses.
We propose to leverage newly available large cohort consortia of child health studies as opportunities to improve the current standards for analyzing and reporting core sociodemographic constructs.
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Bhopal, R. Is research into ethnicity and health racist, unsound, or important science? BMJ 314, 1751–1756 (1997).
James, S. A. Epidemiologic research on health disparities: some thoughts on history and current developments. Epidemiol. Rev. 31, 1–6 (2009).
Seith, D. & Isakson, E. Who are America’s Poor Chidren? Examining Health Disparities among Children in the United States (Mailman School of Public Health, 2011).
National Research Council and Institute of Medicine. Children’s Health, the Nation’s Wealth: Assessing and Improving Child Health (National Academies Press, 2004).
Sanders-Phillips, K., Settles-Reaves, B., Walker, D. & Brownlow, J. Social inequality and racial discrimination: risk factors for health disparities in children of color. Pediatrics 124(Suppl. 3), S176–S186 (2009).
Spencer, N. Social, economic, and political determinants of child health. Pediatrics 112(Part 2), 704–706 (2003).
Marmot, M., Friel, S., Bell, R., Houweling, T. A. & Taylor, S. Commission on Social Determinants of H. Closing the gap in a generation: health equity through action on the social determinants of health. Lancet 372, 1661–1669 (2008).
Daly, M. C., Duncan, G. J., McDonough, P. & Williams, D. R. Optimal indicators of socioeconomic status for health research. Am. J. Public Health 92, 1151–1157 (2002).
Institute of Medicine. Unequal Treatment: Confronting Racial and Ethnic Disparities in Healthcare (National Academies Press, 2003).
Temkin, D., Belford, J., McDaniel, T., Stratford, B. & Parris, D. Improving measurement of sexual orientation and gender identity among middle and high school students. Child Trends 23, 1–2 (2017).
Flores, G. Committee On Pediatric R. Technical report—racial and ethnic disparities in the health and health care of children. Pediatrics 125, e979–e1020 (2010).
American Academy of Pediatrics. Race/ethnicity, gender, socioeconomic status-research exploring their effects on child health: a subject review. Pediatrics 105, 1349–1351 (2000).
Cheng, T. L. & Goodman, E. Committee on Pediatric R. Race, ethnicity, and socioeconomic status in research on child health. Pediatrics 135, e225–e237 (2015).
Walsh, C. & Ross, L. F. Are minority children under- or overrepresented in pediatric research? Pediatrics 112, 890–895 (2003).
Ross, L. F. & Walsh, C. Minority children in pediatric research. Am. J. Law Med. 29, 319–336 (2003).
Brahan, D. & Bauchner, H. Changes in reporting of race/ethnicity, socioeconomic status, gender, and age over 10 years. Pediatrics 115, e163–e166 (2005).
Braveman, P., Cubbin, C., Marchi, K., Egerter, S. & Chavez, G. Measuring socioeconomic status/position in studies of racial/ethnic disparities: maternal and infant health. Public Health Rep. 116, 449–463 (2001).
Case, A. & Paxson, C. Parental behavior and child health. Health Aff. 21, 164–178 (2002).
Kenney, M. K. Child, family, and neighborhood associations with parent and peer interactive play during early childhood. Matern. Child Health J. 16(Suppl. 1), S88–S101 (2012).
Braveman, P. & Barclay, C. Health disparities beginning in childhood: a life-course perspective. Pediatrics 124(Suppl. 3), S163–S175 (2009).
Kuh, D., Ben-Shlomo, Y., Lynch, J., Hallqvist, J. & Power, C. Life course epidemiology. J. Epidemiol. Community Health 57, 778–783 (2003).
Huang, K. Y., Cheng, S. & Theise, R. School contexts as social determinants of child health: current practices and implications for future public health practice. Public Health Rep. 128(Suppl. 3), 21–28 (2013).
Maitland, C., Stratton, G., Foster, S., Braham, R. & Rosenberg, M. A place for play? The influence of the home physical environment on children’s physical activity and sedentary behaviour. Int. J. Behav. Nutr. Phys. Act. 10, 99 (2013).
Sampson, R. J. The neighborhood context of well-being. Perspect. Biol. Med. 46(Suppl.), S53–S64 (2003).
Christian, H. et al. The influence of the neighborhood physical environment on early child health and development: a review and call for research. Health Place 33, 25–36 (2015).
National Institutes of Health (NIH). Final NIH Statement on Sharing Research Data (NIH, 2003).
Gandomi, A. & Haider, M. Beyond the hype: big data concepts, methods and analytics. Int. J. Inf. Manag. 35, 137–144 (2015).
Hamilton, D. Post-Racial Rhetoric, Racial Health Disparities, and Health Disparity Consequences of Stigma, Stress and Racism (Washington Center for Equitable Growth, 2017).
Krieger, N. Epidemiology and the web of causation: has anyone seen the spider? Soc. Sci. Med. 39, 887–903 (1994).
Krieger, N. Theories for social epidemiology in the 21st century: an ecosocial perspective. Int. J. Epidemiol. 30, 668–677 (2001).
Krieger, N., Davey & Smith, G. The tale wagged by the DAG: broadening the scope of causal inference and explanation for epidemiology. Int. J. Epidemiol. 45, 1787–1808 (2016).
Hernandez-Diaz, S., Schisterman, E. F. & Hernan, M. A. The birth weight “paradox” uncovered? Am. J. Epidemiol. 164, 1115–1120 (2006).
Galea, S. & Link, B. G. Six paths for the future of social epidemiology. Am. J. Epidemiol. 178, 843–849 (2013).
Kaufman, J. S. & Cooper, R. S. Commentary: considerations for use of racial/ethnic classification in etiologic research. Am. J. Epidemiol. 154, 291–298 (2001).
LaVeist, T. A. Beyond dummy variables and sample selection: what health services researchers ought to know about race as a variable. Health Serv. Res. 29, 1–16 (1994).
Westreich, D. & Greenland, S. The table 2 fallacy: presenting and interpreting confounder and modifier coefficients. Am. J. Epidemiol. 177, 292–298 (2013).
Kaufman, J. S. Statistics, adjusted statistics, and maladjusted statistics. Am. J. Law Med. 43, 193–208 (2017).
Piccini, P., Montagnani, C. & deMartino, M. Gender disparity in pediatrics: a review of the current literature. Italian J. Pediatr. 44, https://doi.org/10.1186/s13052-017-0437-x (2018).
Coen, S. & Banister, E. What a Difference Sex and Gender Make: A Gender, Sex and Health Research Casebook (Canadian Institutes of Health Research, 2012).
Clayton, J. A. & Tannenbaum, C. Reporting sex, gender, or both in clinical research? JAMA 316, 1863–1864 (2016).
The Society for Women’s Health Research. Institute of medicine report validates the science of sex differences. J. Womens Health Gend. Based Med. 10, 303–304 (2001).
Day, S., Mason, R., Lagosky, S. & Rochon, P. A. Integrating and evaluating sex and gender in health research. Health Res. Policy Syst. 14, 75 (2016).
Nowatzki, N. & Grant, K. R. Sex is not enough: the need for gender-based analysis in health research. Health Care Women Int. 32, 263–277 (2011).
Doyal, L. Sex and gender: the challenges for epidemiologists. Int. J. Health Serv. 33, 569–579 (2003).
Clayton, J. A. Applying the new SABV (sex as a biological variable) policy to research and clinical care. Physiol. Behav. 187, 2–5 (2018).
Krieger, N. Genders, sexes, and health: what are the connections—and why does it matter? Int. J. Epidemiol. 32, 652–657 (2003).
Institute of Medicine. The Health of Lesbian, Gay, Bisexual and Transgender People: Building a Foundation for a Better Understanding (The National Academies Press, 2011).
Ruiz-Cantero, M. T. et al. A framework to analyse gender bias in epidemiological research. J. Epidemiol. Community Health 61(Suppl. 2), ii46–ii53 (2007).
Arboleda, V. A., Sandberg, D. E. & Vilain, E. DSDs: genetics, underlying pathologies and psychosexual differentiation. Nat. Rev. Endocrinol. 10, 603–615 (2014).
Kann, L. et al. Youth risk behavior surveillance—United States, 2015. MMWR Surveill. Summ. 65(Suppl. S6), 1–174 (2016).
Bird, C. E. & Rieker, P. P. Gender matters: an integrated model for understanding men’s and women’s health. Soc. Sci. Med. 48, 745–755 (1999).
Moerman, C. & van Mens-Verhulst, J. Gender-sensitive epidemiologic research: Suggestions for a gender-sensitive approach towards problem definition, data collection and analysis in epidemiological research. Psychol. Health Med. 9, 41–52 (2004).
Jahn, I. & Foraita, R. Gender-sensitive epidemiological data analysis: methodological aspects and empirical outcomes. Illustrated by a health reporting example. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 51, 13–27 (2008).
Nieuwenhoven, L. & Klinge, I. Scientific excellence in applying sex- and gender-sensitive methods in biomedical and health research. J. Women’s Health 19, 313–321 (2010).
Springer, K. W., Mager Stellman, J. & Jordan-Young, R. M. Beyond a catalogue of differences: a theoretical frame and good practice guidelines for researching sex/gender in human health. Soc. Sci. Med. 74, 1817–1824 (2012).
Olson, K. R. & Gulgoz, S. Early findings from the TransYouth Project: gender development in transgender children. Child Dev. Perspect. 12, 93–97 (2018).
Ainsworth, C. Sex redefined. Nature 518, 288–291 (2015).
Krieger, N. in Epidemiology and the People’s Health, 86–92 (Oxford Univ. Press, 2011).
Fullilove, M. T. Comment: abandoning “race” as a variable in public health research—an idea whose time has come. Am. J. Public Health 88, 1297–1298 (1998).
Bhopal, R. & Donaldson, L. White, European, Western, Caucasian, or what? Inappropriate labeling in research on race, ethnicity, and health. Am. J. Public Health 88, 1303–1307 (1998).
Yudell, M., Roberts, D., DeSalle, R. & Tishkoff, S. Science and society. Taking race out of human genetics. Science 351, 564–565 (2016).
Fujimura, J. H. & Rajagopalan, R. Different differences: the use of ‘genetic ancestry’ versus race in biomedical human genetic research. Soc. Stud. Sci. 41, 5–30 (2011).
Morning, A. Does genomics challenge the social construction of race? Sociol. Theory 32, 189–207 (2014).
Office of Management and Budget. Standards for Maintaining, Collecting, and Presenting Federal Data on Race and Ethnicity (OMB, 2016).
Senior, P. A. & Bhopal, R. Ethnicity as a variable in epidemiological research. BMJ 309, 327–330 (1994).
Moubarac, J. C. Persisting problems related to race and ethnicity in public health and epidemiology research. Rev. Saude Publica 47, 104–115 (2013).
Comstock, R. D., Castillo, E. M. & Lindsay, S. P. Four-year review of the use of race and ethnicity in epidemiologic and public health research. Am. J. Epidemiol. 159, 611–619 (2004).
Ahdieh, L. & Hahn, R. A. Use of the terms ‘race’, ‘ethnicity’, and ‘national origins’: a review of articles in the American Journal of Public Health, 1980-1989. Ethn. Health 1, 95–98 (1996).
National Center for Health Statistics. Vital Statistics of the United States: Natality (Centers for Disease Control and Prevention, 1999).
Ho, A. K., Sidanius, J., Levin, D. T. & Banaji, M. R. Evidence for hypodescent and racial hierarchy in the categorization and perception of biracial individuals. J. Pers. Soc. Psychol. 100, 492–506 (2011).
Hickman, C. B. The devil and the one drop rule: racial categories, African Americans, and the U.S. Census. Mich. Law Rev. 95, 1161–1265 (1997).
Jones, C. P., LaVeist, T. A. & Lillie-Blanton, M. “Race” in the epidemiologic literature: an examination of the American Journal of Epidemiology, 1921–1990. Am. J. Epidemiol. 134, 1079–1084 (1991).
Williams, D. R. Race/ethnicity and socioeconomic status: measurement and methodological issues. Int. J. Health Serv. 26, 483–505 (1996).
Passel, J. S. Demographic and social trends affecting the health of children in the United States. Ambul. Pediatr. 2(Suppl.), 169–179 (2002).
Vyas, D. A., Eisenstein, L. G. & Jones, D. S. Hidden in plain sight—reconsidering the use of race correction in clinical algorithms. N. Engl. J. Med. 383, 874–882 (2020).
Centers for Disease Control and Prevention. Use of race and ethnicity in public health surveillance: Summary of the CDC/ATSDR workshop. Morb. Mortal. Wkly. Rep. 17, 42 (1993).
Rivara, F. & Finberg, L. Use of the terms race and ethnicity. Arch. Pediatr. Adolesc. Med. 155, 119 (2001).
Trent, M., Dooley, D. G. & Douge, J. Section On Adolescent H, Council On Community P, Committee On A. The impact of racism on child and adolescent health. Pediatrics 144, e20191765 (2019).
VanderWeele, T. J. & Robinson, W. R. On the causal interpretation of race in regressions adjusting for confounding and mediating variables. Epidemiology 25, 473–484 (2014).
Jones, C. P. Invited Commentary: “race,” racism, and the practice of epidemiology. Am. J. Epidemiol.154, 299–304 (2001).
Liberatos, P., Link, B. G. & Kelsey, J. L. The measurement of social class in epidemiology. Epidemiol. Rev. 10, 87–121 (1988).
Krieger, N., Williams, D. R. & Moss, N. E. Measuring social class in US public health research: concepts, methodologies, and guidelines. Annu. Rev. Public Health 18, 341–378 (1997).
Krieger, N. A glossary for social epidemiology. J. Epidemiol. Community Health 55, 693–700 (2001).
Chittleborough, C. R., Baum, F. E., Taylor, A. W. & Hiller, J. E. A life-course approach to measuring socioeconomic position in population health surveillance systems. J. Epidemiol. Community Health 60, 981–992 (2006).
Currie, J. Healthy, wealthy and wise: socioeconomic status, poor health in childhood, and human capital development. J. Econ. Lit. 47, 87–112 (2009).
de Neubourg, E., Borghans, L., Coppens, K. & Jansen, M. Explaining children’s life outcomes: parental socioeconomic status, intelligence and neurocognitive factors in a dynamic life cycle model. Child Indic. Res. 11, 1495–1513 (2018).
Laflamme, L., Hasselberg, M. & Burrows, S. 20 years of research on socioeconomic inequality and children’s unintentional injuries understanding the cause-specific evidence at hand. Int. J. Pediatr. 2010, 1–23 (2010).
Lynch, J. W. & Kaplan, G. A. Socioeconomic Position (Oxford Univ. Press, 2000).
Galobardes, B., Lynch, J. & Smith, G. D. Measuring socioeconomic position in health research. Br. Med. Bull. 81–82, 21–37 (2007).
Braveman, P. A. et al. Socioeconomic status in health research: one size does not fit all. JAMA 294, 2879–2888 (2005).
Abramson, J. H., Gofin, R., Habib, J., Pridan, H. & Gofin, J. Indicators of social class. A comparative appraisal of measures for use in epidemiological studies. Soc. Sci. Med. 16, 1739–1746 (1982).
Winkleby, M. A., Jatulis, D. E., Frank, E. & Fortmann, S. P. Socioeconomic status and health: how education, income, and occupation contribute to risk factors for cardiovascular disease. Am. J. Public Health 82, 816–820 (1992).
Galobardes, B., Shaw, M., Lawlor, D. A., Lynch, J. W., Davey & Smith, G. Indicators of socioeconomic position (Part 1). J. Epidemiol. Community Health 60, 7–12 (2006).
Braveman, P. & Gottlieb, L. The social determinants of health: it’s time to consider the causes of the causes. Public Health Rep. 129(Suppl. 2), 19–31 (2014).
Vollmer, S., Bommer, C., Krishna, A., Harttgen, K. & Subramanian, S. V. The association of parental education with childhood undernutrition in low- and middle-income countries: comparing the role of paternal and maternal education. Int. J. Epidemiol. 46, 312–323 (2017).
Lindeboom, M., Llena-Nozal, A., Van & der Klaauw, B. Parental education and child health: evidence from a schooling reform. J. Health Econ. 28, 109–131 (2009).
Herring, C. & Henderson, L. Wealth inequality in black and white: cultural and structural sources of the racial wealth gap. Race Soc. Probl. 8, 4–17 (2016).
Arzberger, P. et al. Promoting access to public research data for scientific, economic, and social development. Data Sci. J. 3, 135–152 (2004).
Stockemer, D., Koehler, S. & Lentz, T. Data access, transparency, and replication: new insights from the political behavior literature. Polit. Sci. Polit. 51, 799–803 (2018).
Hammond, R. et al. Predicting childhood obesity using electronic health records and publicly available data. PLoS ONE 14, e0215571 (2019).
Thakrar, A. P., Forrest, A. D., Maltenfort, M. G. & Forrest, C. B. Child mortality in the US and 19 OECD comparator nations: a 50-year time-trend analysis. Health Aff. 37, 140–149 (2018).
Blair, L. M. Publicly available data and pediatric mental health: leveraging big data to answer big questions for children. J. Pediatr. Health Care 30, 84–87 (2016).
Nebeling, L., Dwyer, L. & Oh, A. The FLASHE Study: a publicly available data resource. Curr. Dev. Nutr. 4(Suppl. 2), 1337 (2020).
Ghandour, R. M. et al. The Design and Implementation of the 2016 National Survey of Children’s Health. Matern. Child Health J. 22, 1093–1102 (2018).
Gillman, M. W. & Blaisdell, C. J. Environmental influences on Child Health Outcomes, a Research Program of the National Institutes of Health. Curr. Opin. Pediatr. 30, 260–262 (2018).
We thank Dr. Lisa Jacobson for her guidance and edits on this manuscript. L.T.D. is supported by grants from the National Institute of Mental Health (R25MH083620) and the National Cancer Institute (K01CA184288). This publication was supported by the Environmental Influences on Child Health Outcomes (ECHO) program, Office of the Director, National Institutes of Health, under Award Number U24OD023382 (Data Analysis Center). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.
The authors declare no competing interests.
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Chandran, A., Knapp, E., Liu, T. et al. A new era: improving use of sociodemographic constructs in the analysis of pediatric cohort study data. Pediatr Res (2021). https://doi.org/10.1038/s41390-021-01386-w