Black lives matter: A decomposition of racial inequalities in oral cancer screening

Benjamin Lam, Lisa M. Jamieson, Murthy Mittinty

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(1) Background: The Black Lives Matter movement has highlighted the discrepancies in public health in regard to race. This study aims to investigate tools that can be used to analyze and investigate this discrepancy, which can be applied to policymaking. (2) Methods: National Health and Nutrition Examination Survey (NHANES) data from 2011‐2018 was combined (N = 22,617) to investigate discrepancies of oral cancer screening in Black Americans. We give examples of counterfactual techniques that can be used to guide policy. Inverse probability treatment weighting (IPTW) was used to remove all measured confounding in an interaction analysis to assess the combined effect of socioeconomic status and race. Blinder–Oaxaca decomposition was then used to investigate the intervenable factors associated with differences in race. (3) Results: Sub‐additive interaction was found on additive and multiplicative scales when all measured confounding was removed via IPTW (relative excess risk due to interaction (RERI)(OR) = −0.55 (−0.67–−0.42)). Decomposition analysis found that 32% of the discrepancy could be explained by characteristics of higher education and poverty status. (4) Conclusions: Black Americans in poverty are less likely to seek oral cancer screening than the additive likelihood would suggest. Blinder–Oaxaca decomposition is a strong tool to use for guiding policy as it quantifies clear breakdowns of what intervenable factors there are that would improve the discrepancy the most.

Original languageEnglish
Article number848
Pages (from-to)1-14
Number of pages14
Issue number4
Publication statusPublished - 2 Feb 2021
Externally publishedYes


  • Causal analysis
  • Decomposition
  • Interaction analysis
  • IPTW
  • Marginal structural models
  • MSM
  • Oaxaca decomposition


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