Race/ethnicity misclassification of persons reported with AIDS. The AIDS Mortality Project Group and The Supplement to HIV/AIDS Surveillance Project Group.
ABSTRACT To examine differences in race/ethnicity classifications of persons with AIDS among three reporting sources and to estimate the effect of these differences on calculated AIDS rates.
We reviewed case reports from the national AIDS surveillance database, interview (self-reported) data from 11 state/local health departments, and death certificate information from 16 state/local health departments for agreement in race/ethnicity coding among persons reported with AIDS.
Race/ethnicity coding inconsistencies with AIDS case reports were greatest for persons identified as American Indians/Alaska natives on death certificates (46% [47/102] disagreement) and by self-report (57% 8/14 disagreement). Agreement with AIDS case reports was highest either for persons identified as white from death certificates (4% [1314/31,070] disagreement) and white from self-reports (2% [26/1068] disagreement) or black from death certificates (3% [440/13,592] disagreement) and black from self-reports (3% [21/736] disagreement). For other racial/ethnic groups, disagreement with AIDS case reports was intermediate; for Asians/Pacific Islanders, 12% [45/377] disagreement with death certificates and 33% 4/12 disagreement with self-reports; and for Hispanics, 14% [1151/8527] disagreement with death certificates and 24% [59/249] disagreement with self-reports.
For certain racial/ethnic groups, classification by race/ethnicity can differ substantially by surveillance data source. Because allocation of public health resources may be determined by estimates of disease impact on different population groups, periodic evaluations of the accuracy of race and ethnicity reporting are needed to assure appropriate distribution of these resources.
- SourceAvailable from: ncbi.nlm.nih.gov
[Show abstract] [Hide abstract]
- "Studies have examined the quality of racial and ethnic designations in administrative data from specific states (Baumeister et al. 2000; Boehmer et al. 2002), in public health care programs such Medicare (Pan et al. 1999; Waldo 2005), clinic records (Gomez et al. 2005) and surveillance systems for conditions such as cancer or AIDS (Kelly et al. 1996; Swallen et al. 1997). Few have pursued such questions in a Medicaid population even though they are often the focus of health disparities research. "
ABSTRACT: This paper measures agreement between survey and administrative measures of race/ethnicity for Medicaid enrollees. Level of agreement and the demographic and health-related characteristics associated with misclassification on the administrative measure are examined. Minnesota Medicaid enrollee files matched to self-report information from a telephone/mail survey of 4,902 enrollees conducted in 2003. Measures of agreement between the two measures of race/ethnicity are computed. Using logistic regression, we also assess whether misclassification of race/ethnicity on administrative files is associated with demographic factors, health status, health care utilization, or ratings of quality of health care. Race/ethnicity fields from administrative Medicaid files were extracted and merged with self-report data. The administrative data correctly classified 94 percent of cases on race/ethnicity. Persons who self-identified as Hispanic and those whose home language was English had the greater odds (compared with persons who self-identified as white and those whose home language was not English) of being misclassified in administrative data. Persons classified as unknown/other on administrative data were more likely to self-identify as white. In this case study in Minnesota, researchers can be reasonably confident that the racial designations on Medicaid administrative data comport with how enrollees self-identify. Moreover, misclassification is not associated with common measures of health status, utilization, and ratings of quality of care. Further replication is recommended given variation in how race information is collected and coded by Medicaid agencies in different states.Health Services Research 01/2008; 42(6 Pt 2):2373-88. DOI:10.1111/j.1475-6773.2007.00771.x · 2.49 Impact Factor
[Show abstract] [Hide abstract]
- "The number of APIs with HIV or AIDS is probably underestimated partly owing to race/ ethnicity misclassification in medical records, one of the main sources of information for HIV/AIDS case reports. APIs with Spanish–sounding names (especially for members of the Latin American diaspora of Asians and Filipinos) are often classified as Hispanic (Kelly, Chu, Diaz, Leary, Buehler, 1996; Sy et al., 1998 "
ABSTRACT: Although the percentage of overall AIDS diagnoses remains low among Asian and Pacific Islanders (APIs) in the United States compared with other racial/ethnic groups, research on API risk behaviors and health status suggest that the low number of AIDS cases may not provide a full picture of the epidemic and issues faced by this understudied and underserved population. Data from national HIV/AIDS surveillance systems and the Behavioral Risk Factor Surveillance System (BRFSS) were examined to delineate the magnitude and course of the HIV/AIDS epidemic among APIs in the United States. Same-sex sexual activity is the main HIV risk for API men, whereas heterosexual contact is for API women. APIs are significantly less likely to report being tested for HIV despite the fact that a similar proportion of APIs and other racial/ethnic groups reported having HIV risk in the past 12 months. Given the enormous diversity among APIs in the United States it is important to collect detailed demographic information to improve race/ethnicity and HIV risk classification, conduct better behavioral and disease monitoring for informing prevention planning, and addressing cultural, linguistic, economic and legal barriers to HIV prevention among APIs.AIDS Education and Prevention 11/2005; 17(5):405-17. DOI:10.1521/aeap.2005.17.5.405 · 1.59 Impact Factor
- [Show abstract] [Hide abstract]
ABSTRACT: The Hispanic population in the United States represents more than 40 million individuals, with Mexican Americans (MA) as the largest subgroup. To assess the utility of death certificates and medical records as the source of race/ethnicity data for epidemiologic studies, we compared self-reported race/ ethnicity to race/ethnicity recorded on death certificates and medical records in a bi-ethnic, non-immigrant U.S. community with a significant MA population. This study utilized data collected from a subset of 1,856 participants of the Brain Attack Surveillance in Corpus Christi (BASIC) project. In-person interviews were conducted to determine self-reported race/ethnicity. Of those interviewed, 480 subsequently expired. Using self-reported race/ethnicity as the gold standard, we determined percent agreement, sensitivity, and specificity of the death certificate and medical record. Of the 480 subjects, 259 self-reported their race/ethnicity as non-Hispanic white (NHW), 195 self-reported as MA, and 26 self-reported as non-Hispanic black. Median age was 78.5 years and 55.8% were female. Percent agreement between self-reported race/ethnicity and race/ethnicity recorded on the death certificate and medical record was 97.1% and 96.3% respectively. Five percent of MAs were misclassified as NHW on their death certificates and 3% on their medical records. Results indicated that Hispanic designation recorded on death certificates and medical records in this community was largely consistent with that of self-report. This study suggests that vital statistics data in non-immigrant U.S. Hispanic communities can be used with confidence to investigate ethnic-specific aspects of disease and mortality. Similar studies in other multi-racial communities should be conducted to confirm and generalize these results.Public Health Reports 01/2006; 121(3):275-81. · 1.64 Impact Factor