The Peril and Promise of Racial and Ethnic Subgroup Analysis in Prevention Research

Introduction: Parallel to the growing racial and ethnic diversity in the United States, there has been a growing interest in understanding racial and ethnic disparities in health outcomes, risk and protective processes, and responses to prevention programming. Such interest has led to the increased use of subgroup analysis methods, such as product-term regression and multiple-group structural equation modeling. The use of subgroup analysis is very promising for examining, addressing, and potentially ameliorating via tailored preventive intervention disparities in health. However, there are unique challenges for those conducting subgroup studies, and the possibility of harm resulting from results generated from poorly conducted, non-reproducible subgroup analyses in research is significant.

Method: In this presentation, we review current critiques of subgroup analyses organized within three major practice areas: theoretical, methodological/statistical, and interpretational. We then use this information to propose a two-tiered framework for best practices in (1) exploratory analyses designed to preliminarily reveal and describe group differences as well as (2) confirmatory analyses designed to rigorously test and replicate such differences.

Results: We first outline pervasive suboptimal practices in both exploratory (e.g., lack of theoretical guidance, relaxed statistical practices) and confirmatory (e.g., failing to consider potential confounds, using coarsely defined subgroups) subgroup analyses. Next, we introduce the framework by outlining suggested foundational requirements (e.g., maximizing rigor and transparency, reducing measurement error, implementing community-based participatory research practices) for any type of subgroup study. Within this larger framework, we then recommend theoretical, methodological/statistical, and interpretational best practices for exploratory (e.g., contextualizing subgroup differences, multiple testing with adjustment) and confirmatory (e.g., theory-guided subgroup definitions, testing for confounds and other explanatory factors) subgroup studies.

Conclusions: The possibility of harm resulting from poorly conducted and inadequately reported racial and ethnic group analyses in prevention research is significant. The ultimate goal of this presentation is to propose a framework that advocates for the improvement of research practices that include subgroup member participation and calls for reproducible and transparent results. When applied to policy and practice, these results will inform tailored interventions for minority populations and guide the appropriate allocation of limited resources available for addressing debilitating health disparities.