Race as a Research Variable: Should it be Retained or Discarded?

With all 7.8 billion people on planet Earth (Worldometer, n. d.) sharing 99.9% of the same genetic makeup (NHGRI/NIH, 2011), the categorization of race that we experience is simply not rooted in biology. Biology tells us that we are more alike than different in all meaningful ways. While our differences bring richness through diversity, differences can also be the source of evils when not embraced. One of those evils is racism.

In fact, the Human Genome Project emphasized in 1999 that race is a nonbiological and has no basis in the genetic code (NHGRI/NIH, 2011). Rather, race was socially and politically constructed (Roediger, n. d.). The “racialization” – the process of categorizing, marginalizing, or regarding according to race (Merrian-Webster.com Dictionary, n. d.) – of the United States can be traced to colonial America. As a result of this racialization, racism is about oppression and marginalization. It is about the intersection of power and control in competition with human dignity and fundamental human rights.

In 1790, the federal United States government started counting its people and included race as a data point (Brown, 2020). From 1790 to 1950, individuals were not allowed to self-identify their own race during the decennial census; it was assigned to them (Parker et al., 2015a). Starting with the 1960 decennial census, individuals could choose their own race although they were forced to pick only one. And it was only 21 years ago, with the 2000 decennial census, that individuals were allowed for the first time to self-identify with more than one race (Parker et al., 2015a).

According to research by the Pew Research Center (Parker et al., 2015b), an estimated 6.9% of adult Americans self-identify as multiracial although 2019 data from the United States Census indicated that 2.8% of Americans identified with one or more race (Census Bureau, 2019). Related, 39.9% of the U.S. population self-identifies as Black or African American, American Indian or Alaskan Native, Asian, Native Hawaiian or Other Pacific Islander, with two or more races, and/or Hispanic or Latino (Census Bureau, 2019).

Like the U. S. Census, individuals seeking healthcare are routinely asked to self-identify their race and ethnicity on demographic forms in health systems. In research, investigators frequently ask for these self-identified classifications as well. Considering that race has no biological basis and is rooted in social and political structures, do we really need to be collecting information about race?

In a recent opinion piece published in JAMA (25 January 2021), “Recalibrating the Use of Race in Medical Research”, Ioannidis and colleagues stated, “differences observed in research studies between ‘races’ may result from the multifarious consequences of long-entrenched and continuously transformed racism” (p. E1). As they asserted, if race is a socially constructed variable, should we also consider other social constructs that impact health inequities and not just focus on race?

If we were to eliminate race as a research variable, is there potential to cause harm? Let us consider the impact of COVID-19 on life expectancy in the United States. In recent research published by Woolf and colleagues (2021), they reported that “life expectancy in the U.S. decreased disproportionately among racial and ethnic minority groups between 2018 and 2020, declining by 3.88, 3.25, and 1.36 years in Hispanic, non-Hispanic Black, and non-Hispanic White populations, respectively” (p. 1). In this instance, if race and ethnicity had not been considered, we may not have been able to appreciate that “longstanding and widening U.S. health disadvantage, high death rates in 2020, and continued inequitable effects on racial and ethnic minority groups are likely the products of longstanding policy choices and systemic racism” (p. 1). In this situation, eliminating race might have prevented what clinicians and community members in the United States already knew – that Black and Brown persons were dying from COVID-19 at rates higher than their White counterparts. But, would we have identified that the life expectancies of these groups had actually regressed? Probably not.

As HIV nurses, we already know that Black, Latinx, and Indigenous communities are disproportionately impacted by HIV. In this situation, it is critical that we consider the social constructs that are driving the epidemic in these populations and not continue to focus on the inequities associated with HIV among diverse racial and ethnic groups. According to Ioannidis and colleagues (2021),

“race as a measure should be abandoned, and efforts should be diverted toward findingvariables that are more robust and informative, both for the biological constructs (e.g., genetic ancestry) and the sociologic ones (e.g., discrimination, deprivation, socioeconomic status) for which race has failed to provide useful, reproducible insights” (p. E1).

Further, should we focus on mitigating the negative effects of stigma which is a known source of population health inequities (Hatzenbeuhler at al., 2013) and consider experiences with everyday discrimination, medical distrust, health literacy, and the social contributors of health? The challenge with many of these social constructs is that they are non-standardized and crudely measured (Ioannidis et al., 2021).

In his book, In Search of a Better World: Lectures and Essays from Thirty Years (1996), philosopher of science Karl Popper stated, “Our aim as scientists is objective truth; more truth, more interesting truth, more intelligible truth. We cannot reasonably aim at certainty” (p. 4). If science is about the pursuit of truth, are we seeking truth when race is used as a fixed category in our research? As HIV nurses, we also believe our social and ethical responsibility is to promote truth, ensure equity, and foster inclusion.

As the editorial leadership team of JANAC, we have engaged in discussions and begun to look at how “race” is considered in the analyses of submissions to the journal. In some instances, we may ask authors to consider redoing their analyses to better address the social constructs related to the phenomenon of inquiry. For example, examining differences between White and non-White persons living with HIV may no longer be considered informative and appropriate without a substantive examination, or hypothesizing as to why those differences might exists. Further, if race is found to be a significant predictor of some outcomes, authors should consider deconstructing race in the discussion section integrating the extant literature about what social constructs might influence outcomes.

As always, JANAC welcomes the respectful discussion of diverging perspectives and opinions. If you have a different perspective, please consider submitting a Letter to the Editor or a Commentary as it is critical for nursing and HIV prevention, care, and treatment outcomes that we engage in a scholarly discourse around these complex issues.