Using race as a social construct when looking at differences in racial associations between non-alcoholic fatty liver disease and type 2 diabetes. Reply to Rollin FG, Washington C, Fluker S-A [letter]

To the Editor:

We would like to thank Rollin et al [1] for their commentary on our study [2] and for bringing up critical issues that should be carefully considered and addressed when discussing study findings in the context of race. In our study, non-alcoholic fatty liver disease was associated with a higher risk of type 2 diabetes among White participants but not among Black participants [2]. As Rollin et al stated [1], and we wrote in the discussion of our paper, self-reported race should not be used as a proxy for genetic ancestry in research [2, 3]. Thus, we agree that our study results should be interpreted as the result of differences in social determinants of health and not inherent biological differences. Further investigation of structural and social mechanisms beyond those that we were able to assess, such as racism [4], lack of access to healthcare [5–7] and inadequate quality of care [8], would provide better context to our findings. We deeply appreciate the letter from Rollin et al [1] and the opportunity to make clear our intent and correct our imprecise language to ensure that readers interpret our findings in the appropriate context.