Document Detail


Rigor, vigor, and the study of health disparities.
MedLine Citation:
PMID:  23045672     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
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 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, 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.
Authors:
Nancy Adler; Nicole R Bush; Matthew S Pantell
Publication Detail:
Type:  Journal Article; Review     Date:  2012-10-08
Journal Detail:
Title:  Proceedings of the National Academy of Sciences of the United States of America     Volume:  109 Suppl 2     ISSN:  1091-6490     ISO Abbreviation:  Proc. Natl. Acad. Sci. U.S.A.     Publication Date:  2012 Oct 
Date Detail:
Created Date:  2012-10-17     Completed Date:  2013-01-16     Revised Date:  2013-07-11    
Medline Journal Info:
Nlm Unique ID:  7505876     Medline TA:  Proc Natl Acad Sci U S A     Country:  United States    
Other Details:
Languages:  eng     Pagination:  17154-9     Citation Subset:  IM    
Affiliation:
Department of Psychiatry, University of California, San Francisco, CA 94143-0848, USA. nancy.adler@ucsf.edu
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MeSH Terms
Descriptor/Qualifier:
Causality
Child
Continental Population Groups
Ethnic Groups
Healthcare Disparities* / economics
Humans
Poverty
Research Design
Risk Factors
Social Class
Social Environment
Stress, Physiological
Comments/Corrections

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