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Kaufman, Jay S.; Millikan, Robert C.; Poole, Charles L.; Godley, Paul A.; Cooper, Richard S.; & Freeman, Vincent (2000). Re: "Differences in Socioeconomic Status and Survival among White and Black Men with Prostate Cancer". American Journal of Epidemiology, 152(5), 493.


The strategy of adjusting racial differentials for measures of social status to separate the “biologic” and “nonbiologic” pathways that produce these disparities has elicited significant criticism. The problems are numerous: Causal parameters for race effects of interest are not well defined (1). Deficiencies in the specification or measurement of causal intermediates can lead to spurious apparent race effects (2). Measured intermediates are inherently inadequate because of incommensurability of social measures between racial groups (3). Adjustment is made for factors that are causally subsequent to exposure (4). Finally, even if race were considered a meaningful “exposure” and assumed (however absurdly) to be essentially randomized to individuals, this assumption would be sufficient only to identify total effects of race; effects transmitted through direct or indirect pathways still would not be separately identifiable without additional, unrealistic assumptions about factors affecting both measured intermediates and disease outcome


Reference Type

Journal Article

Year Published


Journal Title

American Journal of Epidemiology


Kaufman, Jay S.
Millikan, Robert C.
Poole, Charles L.
Godley, Paul A.
Cooper, Richard S.
Freeman, Vincent