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Ralph Groves, MD, National Epidemiology Program, Indian Health Service, 5300 Homestead Rd. NE, Albuquerque, NM 87110, 505-248-4226, ralph.groves@mail.ihs.gov, David King Espey, MD, Indian Health Service National Epidemiology Program, 5100 Homestead NE, Albuquerque, NM 87110, T Flood, MD, Bureau of Public Health Statistics, Arizona Dept. of Health Services, 150 N 18th Ave; Ste 550, Phoenix, AZ 85007-3248, G Copeland, Vital Records and Health Data, 3423 N ML King Blvd, Lansing, MI 48906, B Woods, Office of New Mexico Vital Records and Health Statistics, 1105 St. Francis Drive, Santa Fe, NM 87501, and K Baker, MPH, Health Care Information, Oklahoma State Department of Health, 1000 NE 10th Street- Room 807, Oklahoma City, OK 73117.
Background: Studies have shown that race is miscoded on death certificates for up to 15% of American Indians and Alaska Natives (AI/AN). Infant mortality data reveal even higher rates of misclassification. Because mortality rates estimate disease burden and enable prudent planning of prevention and control efforts, the accuracy of these rates is essential. Methods: We conducted probabilistic linkages with the Indian Health Service patient registry and state mortality data for the years 1994-1998 from Arizona, Michigan, New Mexico and Oklahoma. We classified matches as correctly or incorrectly coded AI/AN, and merged these records with non-matches coded as AI/AN to establish the total cohort of AI/AN decedents. We analyzed the cohort to determine predictors of racial misclassification. Results: The number of incorrectly classified AI/AN deaths was 109 (2.2%) for New Mexico, 248 (3.1%) for Arizona, 97 (4.6%) for Michigan, and 3270 (32.9%) for Oklahoma. The newly identified deaths resulted in all-cause AI/AN mortality increases of 2.3%, 3.2%, 4.8%, and 49.1% respectively. Decedents with a higher degree of AI/AN ancestry (blood quantum) were more likely to have been correctly classified at death (trend test, p<.0001). Among those misclassified, 95.4% were coded as white. Sex, age, and year of death were not associated with likelihood of misclassification. Conclusions: Racial misclassification of AI/AN deaths leads to underestimation of AI/AN mortality rates. The magnitude of underestimation is correlated with blood quantum. Persons who complete death certificates or maintain vital statistics should be aware of the extent of misclassification and employ measures to improve accuracy.
Learning Objectives: At the conclusion of the session, the participant in this session will be able to
Keywords: Mortality, Native Americans
Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.