Nancy Krieger

Dr. Krieger was a panelist for the Forum’s discussions on Race, Criminal Justice and Health and Revisiting Health, Criminal Justice, and Health.

Dr. Nancy Krieger’s work focuses on social inequalities in health. She is a social epidemiologist, with a background in biochemistry, philosophy of science, history of public health, and involvement as an activist in issues involving social justice, science, and health. Her work involves: (a) etiologic studies of health inequities, (b) methods for improving monitoring of social inequalities in health, and (c) development of theoretical frameworks, including ecosocial theory, to guide work on understanding and addressing societal determinants of health.

In April 2011, Dr. Krieger’s book, Epidemiology and the People’s Health: Theory and Context, was published by Oxford University Press. This book presents the argument for why epidemiologic theory matters. Tracing the history and contours of diverse epidemiologic theories of disease distribution from ancient societies on through the development of — and debates within — contemporary epidemiology worldwide, it considers their implications for improving population health and promoting health equity.

In her current empirical epidemiologic research, she is investigating:

Racial discrimination and risk of chronic disease

This study, based in several community health centers in Boston, is investigating different approaches to measuring exposure to racial discrimination (both explicit and implicit) and examining the association of these exposures with the occurrence of well-known behavioral, anthropometric and physiological risk factors for chronic disease, including cardiovascular disease, diabetes, and cancer.

Jim Crow & Health Disparities: Exploring Age-Period-Cohort Effects

This study is using long-term US mortality data to explore how best, conceptually and methodologically, to integrate use of age-period-cohort (APC) analysis to advance understanding of determinants of trends in the magnitude of health inequities. The focus is on Jim Crow: the impact of both its existence and abolition on mortality in the US, overall and in relation to race/ethnicity and socioeconomic position.

Exploring Trends in US Health Inequities in Context: NHES to NHANES, 1959-2006

This study seeks to examine the changing magnitude of US health inequities, in relation to socioeconomic position and race/ethnicity, using data on measured health characteristics obtained in the US National Health Examination Surveys and the National Health and Nutrition Examination Surveys, spanning from 1959-2006.

Recently completed studies include:

Area-Based Socioeconomic Measures for Health Data

This epidemiologic investigation has demonstrated the utility of using US census tract poverty data for monitoring socioeconomic inequalities in health. It did so by evaluating which area-based measures of socioeconomic position, at which level of geography (census tract, census block group, or ZIP Code), are appropriate for US public health surveillance systems and health research. The goal is to improve capacity for monitoring socioeconomic inequalities in health in the United States. Health data for this project were obtained from public health surveilance systems in 2 states (Massachusetts and Rhode Island), and pertain to: mortality (all-cause and cause-specific), cancer incidence (all sites and site-specific), low birthweight, childhood lead poisoning, sexually transmitted infections, tuberculosis, and non-fatal weapons-related injury. Visit our Public Health Disparities Geocoding Project Monograph website (listed below) for a discussion of our project, plus free access to our publications and a sample data set (Geocoding Project )

Measuring racial discrimination for health research

This is the validation study for the “Experiences of Discrimination” (EOD) instrument designed to measure self-reported experiences of racial discrimination. The validation study was conducted in both English and Spanish among a random sample of African American and Latino/a low-wage workers showed the instrument has good psychometric properties. For free access to the instrument and information on how it can be used, see register for access to EOD instrument

In 2010 we published new preliminary studies indicating the value of using both explicit measures of self-reported experiences of racial discrimination (such as the EOD) along with measures of exposure obtained using the methodology of the Implicit Association Test (IAT).

Physical and Social Hazards: Jobs, Race, Gender, and Health

This union-based study, led by Dr. Elizabeth Barbeau (PI), has examined how workplace hazards, both physical (e.g., noise, ergonomics) and social (e.g., discrimination, sexual harassment), affect workers’ health at work and at home. The study uses the newly validated “Experiences of Discrimination” (EOD) instrument developed by Krieger to measure self-reported experiences of racial discrimination.

Cancer and Changing Trends in US Mortality Inequities: 1960-2004

Building on her recent work which showed that in the period from the mid-1960s to 1980, inequities in premature mortality and infant death shrank in the US, but then increased or stagnated thereafter — a finding that empirically refutes the widespread view that as population health improves, it is inevitable that health inequities will rise (because the better off always benefit most from progress) — this study examined temporal trends in the magnitude of health inequities for cause-specific mortality for outcomes ranging from specific types of cancer to deaths preventable by medical intervention.

Breast cancer incidence after the Women’s Health Initiative Study

This study documented that, as hypothesized, incidence rates did not decline equally among all women, but instead declined only among white women who lived in affluent counties and who had estrogen receptor positive (ER+) tumors, meaning that the decline occurred chiefly among the women most likely to have used hormone therapy and who had the types of tumors most liked to exposure to hormone therapy.

Socioeconomic trends in breast cancer incidence

This study assessed whether the socioeconomic gradient in breast cancer is changing, using US cancer registry data from the past 30 years. Key findings are that the socioeconomic gradient has remained unchanged among US white and black women, but has increased among Hispanic and Asian and Pacific Island women, i.e., groups with a higher proportion of immigrants arriving from countries that exhibit the stronger class gradients evident among regions with lower breast cancer incidence rates.

Racial/ethnic disparities in breast cancer estrogen receptor status

This study assessed whether conventional estimates of racial/ethnic disparities in breast cancer estrogen receptor (ER) status for breast tumors are biased by missing data on ER status, a lack of socioeconomic data, and inappropriate modeling assumptions. It demonstrated these problems lead to inflation of the estimates of racial/ethnic and socioeconomic disparities in ER status.