Reporting Patterns: Racialized Inequities in Military Health Research

Background

Numerous guidelines provide recommendations for reporting racialized inequities in health and healthcare research. However, dissemination and utilization of such guidelines may be stymied. This scoping review aims to understand how radicalized inequities among U.S. active duty service members are described in research and to what extent these descriptions align with recommended reporting practices.

Methods

This systematic scoping review was conducted using PubMed, CINAHL, PsycINFO, and Embase databases. Studies published between January 2022 and February 2023 that focused solely on U.S. active duty service members and health outcomes were included. Studies were excluded if racialized inequities were not described in both the Results and Discussion sections. Articles underwent abstract screening, full-text review, and data extraction by multiple co-authors. Data were analyzed using descriptive statistics.

Results

Of the 1,083 screened studies, 21 met the inclusion criteria. Most studies (81%) included multiple military services and relied on administrative record extraction, where race and ethnicity were self-reported (86%). However, none of the studies explicitly provided a structurally responsive rationale for including race and ethnicity in analyses. Instead, racialized inequities were often attributed to race as a risk factor (57%) rather than to structural determinants. Additionally, 86% of studies aggregated service members into broad racial categories such as “other” or “other and unknown.” Language inconsistencies were common, with 52% using “race/ethnicity” or “Asian/Pacific Islander,” 29% using “non-White,” and 29% referring to race or ethnicity as nouns (e.g., “Blacks”). Only 14% explicitly referenced structural determinants of radicalized inequities.

Discussion

The findings indicate a limited use of structurally responsive language describing racialized inequities in the included publications focused on U.S. active duty service members. Race and ethnicity were frequently conceptualized as risk factors, and in one instance, as a biological construct, rather than as proxies for structural and institutional inequities. These results align with prior research indicating that racial and ethnic identities are often underreported or underrepresented in clinical trials and healthcare studies. To improve dissemination of reporting recommendations, journals and research institutions should implement structured guidelines and training programs emphasizing the use of health equity frameworks. Additionally, researchers could be encouraged to incorporate discussions of structural and institutional factors contributing to inequities, rather than solely presenting race as an explanatory variable.

Conclusion

This scoping review highlights critical gaps in the reporting of racialized inequities in health research involving U.S. active duty service members. Addressing these gaps through improved research practices, targeted education, and enforcement of reporting guidelines may enhance the structural competency of future studies. These efforts could contribute to more effective strategies for mitigating racialized inequities within the Military Health System.