14.K. Skills building seminar: Studying health inequalities: Intersectional approaches to quantitative research

Abstract

Abstract Analysis of health inequalities is commonly done through comparisons across social identities or positions across a single axis (e.g., by gender, ethnoracial group, immigration status and age separately). While comparisons across some of these axes may suggest differences related to biology (e.g., ageing or cumulative exposures), many are important social determinants of health. Here numeric inequalities may serve as indicators of social equity issues that impact health. Intersectionality is a theoretical framework originating within feminist legal theory, but that has been incorporated across many disciplines. Its focus on impacts of social power, heterogeneity of experiences and outcomes, and specificity of experiences within intersectional groups have all resonated within public health. While it has been highly influential within qualitative research, the incorporation of intersectionality in quantitative research is more recent. This has raised questions regarding best (or even appropriate) practices for research design, measurement, and statistical analysis. Intercategorical approaches to intersectionality focus on examining outcomes and effects across cross-stratified social groups, whereas intracategorical approaches focus on heterogeneity within a population sub-group. As public health researchers, this allows us to move beyond single-axis analyses of inequalities to examine how health may be shaped differently at different intersectional positions (e.g., for young immigrant Asian men). This provides the potential for descriptive analyses of inequalities that more accurately capture health risks by avoiding assumptions that average differences for each axis can be simply summed. Moreover, this provides the potential for analytic studies identifying potential causal drivers of such inequalities that may serve as intervention targets. In this skills-building workshop, we begin with an overview of considerations in incorporating intersectionality into public health, as well as frameworks for distinguishing intra- and intercategorical approaches, and descriptive and analytic intersectional studies. We then present a deeper examination of the statistical and pragmatic performance of seven different statistical approaches to intercategorical descriptive data analysis, with applications for large population health surveys or administrative data sets. Workshop participants will work in small groups to approach case studies of applications to population survey data, in order to better understand analysis options in comparison with those obtained through more standard single-axis analyses. Key messages We present considerations in incorporating intercategorical intersectionality into public health to improve evaluation of health inequalities and to inform intervention strategies. We present a comparative evaluation of statistical methods for intersectional analysis of inequalities, and workshop approaches to research in real-world scenarios.