Intersectionality-based quantitative health research and sex/gender sensitivity: a scoping review.

Background: The implementation of a theoretical intersectionality framework into quantitative data analyses is gaining increasing interest in health research. The substantive foundation of intersectionality was established in the U.S., based on the claim of black feminists to broaden the scope of contemporary gender studies by considering the intersection between sex/gender and race/ethnicity more firmly. The aim of our scoping review with particular emphasis on sex/gender was to assess how intersectionality-informed studies in epidemiological research considered different social dimensions in their multivariable and multivariate analyses.

Methods: Following the PRISMA Extension for Scoping Reviews (PRISMA-ScR), we conducted a literature review in PubMed. Three distinct health-related fields were brought into focus: diabetes representing a frequent chronic disease, smoking as a wide-spread behavioural health determinant and physical activity as a central target for health promotion. Initially, we compared which and how different social dimensions were accounted for and how inter-categorical and intersectionality-informed analyses were conducted. Further, we assessed sex/gender sensitivity by comparing operationalisation of sex/gender, how sex/gender theories were used and which central theoretical sex/gender concepts were referred to when aiming at explanation of (intersectional) sex/gender differences.

Results: Our results suggest, that intersectionality-based analyses within the three selected health-related fields are mainly conducted in the U.S. and focused on the intersection between sex/gender and race/ethnicity by using them jointly as subgrouping variables and as parts of interaction terms in regression analyses. Income and education as proxies for social class as well as age are mainly used for adjustment in quantitative analyses. Other approaches for calculating interactions (i.a. synergy-index, CART-analysis) are an exception. Even though sex/gender was considered in every included study and Gender was the most frequent theoretical sex/gender concept referred to when theoretically explaining sex/gender differences, it was exclusively operationalised as binary and solution-linked sex/gender variables were hardly considered in quantitative analyses.

Conclusion: The systematic integration of solution-linked variables indicating modifiable aspects of sex/gender-related living conditions and disadvantages could improve sex/gender sensitivity as part of intersectionality-based quantitative data analysis in health research.