When Strokes Strike Harder: Mapping and Racializing Risk in the REGARDS Brain Health Study

• In Event: 30669 - Knowledge #1: Data, Risk, and Knowledge in Health Policy

Abstract

This thesis proposal explores the operationalization and institutional coupling of race and geography in the REasons for Geographic and Racial Differences in Stroke (REGARDS) study as a value-laden process in which science and society co-produce epistemological conventions about social facts. REGARDS, a 30,239-participant prospective cohort study, contributes to a public health effort to understand why strokes strike harder in the Southeastern US and amongst Black Americans. REGARDS limits its racial analysis to self-reported non-Hispanic Black and white participants and uses residence-based regional boundaries such as the “Stroke Belt.” The reification of racial and geographic disparities as causal mechanisms of stroke mortality exemplifies a persistence in epidemiological research to operationalize constructs into stable, measurable categories, even as the ambiguity of these constructs remains acknowledged. Why does REGARDS base its research in a reductionist, binary racial framework and delimited geographic region as an explanatory frame for observed disparities in stroke mortality? This research examines the intellectual, political, and institutional rationales behind these design choices, asking how such classifications become embedded in epidemiological research and their implications for public health knowledge production.

To engage this puzzle, the study employs a triangulated qualitative research design, incorporating 15 semi-structured interviews with REGARDS personnel alongside a discursive analysis of the 50 most-cited REGARDS publications. In addition to study outputs, this research will examine how classificatory decisions take shape by attending spaces where REGARDS is actively discussed—such as research meetings, conferences, and settings where study protocols and findings are debated. By investigating the motivations and negotiations underpinning REGARDS’ methodological decisions, this study aims to shift the clinical gaze and “study up” — what (di)visions of society and health do these bureaucratic, institutional, and discursive processes of knowledge production serve to reproduce and provide cover for, diverting attention from distal mechanisms of risk distributed unequally in society?

Authors

• London Sinclair, University of Vermont

• Jonathan David Shaffer, University of Vermont