Session 3: An Intro & Overview of Health Disparities Research (Patel)

Click here for a word document of the following.   

Learning Objectives:

  1. Identify frameworks for identifying, describing, and remedying health disparities
  2. Limits and strengths of research designs for the study health disparities, including observational designs, and potential limits of experimental designs
  3. Identify and critically appraise measures of “race/ethnicity” and “socioeconomic status”

Reading and Preparation:

The following is a list of articles that you should use to prepare answers to the questions that follow. My suggestion is to read the questions first, and then use the articles to answer them – I indicate which articles to draw answers from.


1. Wong MD; Shapiro MF; Boscardin WJ; Ettner SL. Contributions of major disease to disparities in mortality. NEJM 2002; 347: 1585-1592

2. Krieger N, et al. Painting a truer picture of US socioeconomic and racial/ethnic health inequalities: The public health disparities geocoding project. AJPH 2005; 95:312-323.

3. Kilbourne AM; Switzer G; Hyman K, Crowley-Matoka; Fine MJ. Advancing health disparities research within the health care system: a conceptual framework. AJPH 2006; 96: 2113-2121.

4. Stewart AL, Napoles-Springer AM. Advancing health disparities research: Can we afford to ignore measurement issues? Medical Care 2003; 41:12-7-1220 (read only 1207-1211).

5. Look at Figure 1 from: James SA. Epidemiologic research on health disparities: some thoughts on history and current developments. Epidemiologic Reviews, 2009; 31: 1-6. (rest optional)


Isaacs SL; Schroeder SA. Class – the ignored determinant of the nation’s health. NEJM, 2004; 351: 1137-1142.

Braveman PA, et al. Socioeconomic status in health research: One size does not fit all. JAMA 2005; 294:2879-2888.

Winker MA. Measuring race and ethnicity: why and how? JAMA 2004; 292:1612-1614.

Cooper LA, et al. Designing and evaluation interventions to eliminate racial and ethnic disparities in health care. JGIM 2002; 17:477-486.Cooper_DesignEvalInternvention_JGIM2002.pdf

Rathore SS; Krumholz HM. Differences, disparities, and biases: clarifying racial variations in health care use. Annals of Internal Medicine 2004; 141:635-638.


1. a. In Wong’s article, describe the main factors he examines/defines as the predictors of disparities in mortality. How are these factors measured and defined in his study?

1. b.  Comment on this strategy – do you believe it is a “complete” measure of the social status? What are the pros and cons of his choices?  Does Wong check (via a “sensitivity analysis”) whether these are accurate?


1 c. What underlying construct is Wong measuring by using educational status? (see articles by Isaacs, Stewart)


2.a. Explain what measure(s) Krieger uses to measure social status in her paper.

2.b. Do you see any advantages in her approach? Disadvantages?

2.c. Based on Stewart’s conceptual framework, what does Wong omit in his approach? How might this affect his findings?

2.d. Do you think Krieger’s approach is more “complete”(why/why not)? How might this affect her findings?


3. What, if any, measures of social status/experience that potentially affect mortality are missing from these 2 papers?


4. According to Wong, what diseases contribute most to disparities in mortality between blacks and white? Between persons of lower and higher educational levels?


5. Krieger creates a ratio called the “population attributable fraction” to describe her findings. In Table 2 of her paper, interpret her findings about HIV/AIDS among men in terms of the “RR” and the “PAF” (p 321).


6. In the framework Kilbourne describes, what “phase" of health disparities research does Wong and Krieger’s work correspond to?


7.a Choose 1 disparity identified in Wong’s or in Krieger’s article:


7.b. Name 3 possible reasons for the etiology for this disparity. (To answer this question, read: Kilbourne article; Figure 1 from James article, and Isaacs article). Why do you hypothesize these reasons? What “phase” of disparities research does this question correspond to?


7.c. Describe the study design you might use to test “why” this disparity occurs. Please include whether it is: OBSERVATIONAL or EXPERIMENTAL; QUANTITATIVE OR QUALITATIVE, and whether it is MULTILEVEL or not. (read Kilbourne)