Ten years later: future directions from our most cited paper on the minority tax

Background: In the last ten years there has been a large body of literature exploring the impact of the minority tax on minoritized groups in medicine. A team of authors including an author of this manuscript (KMC) published an article in 2015 that defines the minority tax. This current article looks to describe the progress made in addressing the minority tax by reviewing scholarly publications over the last nine years, assess the strength of articles published, and identifying where continued efforts are needed to eliminate the minority tax. Methods: Four databases were used to identify publications which cited the 2015 seminal paper on the minority tax. All articles were reviewed for strength of recommendation taxonomy (SORT) criteria. All A and B level articles were then categorized into a process phase of the Define, Measure, Analyze, Improve and Control (DMAIC) method. Results: 482 articles met inclusion criteria for the study, 35.9% of the articles were given an A-level, 33.4% a B-level, and 30.7% were given a C-level. More than 90% of the A and B level articles slot in the measure (n = 82), analyze (n = 108), and improve (n = 116) steps of the DMAIC model. The define category had the lowest number of articles (n = 6) followed by the control step (n = 22). Conclusions: Most publications regarding the minority tax measure the scope, analyze root causes, and suggest interventions. Additional publications are needed of SORT level A and B on how to control the minority tax.