[EQ] Rigor, vigor, and the study of health disparities

Rigor, vigor, and the study of health disparities

Nancy Adler a,b,1, Nicole R. Bush a, and Matthew S. Pantell b,c

A Department of Psychiatry, and

B Department of Pediatrics University of California, San Francisco, CA 94143-0848; and

C University of California San Francisco–University of California Berkeley Joint Medical Program, University of California, Berkeley, CA

Edited by Gene E. Robinson, University of Illinois at Urbana–Champaign, Urbana, IL

PNAS October 16, 2012 vol. 109 no. Supplement 2 17154-17159

Available online at: http://bit.ly/TvsnQ5

“……Health disparities research spans multiple fields and methods and documents strong links between social disadvantage and poor health. Associations between socioeconomic status (SES) and health are often taken as evidence for the causal impact of SES on health, but alternative explanations, including the impact of health on SES, are plausible. Studies showing the influence of parents’ SES on their children’s health provide evidence for a causal pathway from SES to health, but have limitations.

Health disparities researchers face tradeoffs between “rigor” and “vigor” in designing studies that demonstrate how social disadvantage becomes biologically embedded and results in poorer health. Rigorous designs aim to maximize precision in the measurement of SES and health outcomes through methods that provide the greatest control over temporal ordering and causal direction.

To achieve precision, many studies use a single socioeconomic status SES predictor and single disease. However, doing so oversimplifies the multifaceted, entwined nature of social disadvantage and may overestimate the impact of that one variable and underestimate the true impact of social disadvantage on health. In addition, socioeconomic status SES effects on overall health and functioning are likely to be greater than effects on any one disease.

Vigorous designs aim to capture this complexity and maximize ecological validity through more complete assessment of social disadvantage and health status, but may provide less-compelling evidence of causality. Newer approaches to both measurement and analysis may enable enhanced vigor as well as rigor. Incorporating both rigor and vigor into studies will provide a fuller understanding of the causes of health disparities. …..”

 

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