Few Studies Assess Social Determinants of Health Intervention by Race

Less than a third of studies investigating social determinants of health interventions include race and ethnicity in their analyses, and even fewer stratify intervention outcomes by race, according to a new study from University of California San Diego Health researchers.

This stymies any efforts to understand how social determinants of health interventions can address racial health disparities, the researchers contended.

“Over the last decade, achieving health equity has been heralded as a key priority for health care delivery organizations,” the researchers wrote in JAMA Network Open. “Health equity is achieved when all individuals have the opportunity to achieve their full health potential and no one is prevented from doing so. Achieving health equity requires addressing root causes of health inequities, including inequities in social and structural drivers (determinants) of health.”

Given the rise of value-based care, the industry has focused its attention on social determinants of health within the past few years. But in order to truly understand how social determinants of health interventions will also help address health equity, analysis of how those interventions impact different racial groups needs to be done.

According to a literature review of 152 studies, the researchers found that very few investigations are looking at SDOH outcomes and race. Only 44 studies included race or ethnicity in their analyses. That means only 44 studies collected data about participant race or ethnicity; the remainder did not, hamstringing any efforts to assess how the intervention impacted individual racial groups.

Of those 44, only four were conceptually thoughtful, or “explicitly or implicitly noted that race or ethnicity are markers of exposure to racism,” the researchers said.

Meanwhile, only a subset of studies looked at racial disparities in SDOH intervention outcomes. The researchers said 21 studies noted if outcomes differed by race or ethnicity, while 23 referenced race or ethnicity in their analyses as confounders. The remaining 108 studies did not outline racial differences in SDOH intervention outcomes.

This is a serious pitfall as healthcare experts design SDOH interventions.

“Because of the persistent and pervasive nature of racism, it is likely that social needs interventions operate differently in minoritized racial and ethnic populations,” the researchers explained.

“Failure to assess for differential outcomes by race or ethnicity prevents us from understanding whether minoritized racial and ethnic populations benefit from interventions at least as much as White populations prevent us from advancing our understanding of how social needs interventions can reduce racial or ethnic health inequities.”

Filling this gap in understanding will be critical as healthcare continues on its promise to address health equity. Since 2020, many leading healthcare organizations have committed to addressing health equity. But fulfilling those commitments will be fruitless if industry stakeholders don’t know how SDOH interventions can contribute to that cause.

Advancing this work must begin with better education, the researchers indicated. Researchers may not explain their use of race and ethnicity in SDOH investigations because they are not aware of the importance of doing so or even have limited knowledge about how racism—not race—influences SDOH risk.

The team advised using its own two-concept framework, which they used to analyze the studies included in their literature review.

“Our categorization framework can help individuals and groups that conduct systematic reviews by focusing on information with the highest utility for advancing racial health equity,” they said. “For systematic reviews that support clinical practice guideline development, routine synthesis of differences in effectiveness by race or ethnicity that do not consider analytical informativeness and conceptual thoughtfulness may exacerbate health inequities by perpetuating what has been termed scientific racism, or the belief that racial hierarchies are explained by biological differences.”

Moreover, more work can be done on the publishing side. The researchers posited that word count limits have gotten in the way of researchers outlining their inclusion of race and ethnicity in analysis. Reconsidering publishing guidelines may help expand knowledge about the intersection of race, SDOH, and health outcomes.

“Changing the expectations of peer reviewers and journal editors about how race and racism are handled from conceptualization through data analyses and interpretation, and implications of the work, would facilitate this process,” they concluded.