Underreporting of American Indian race on North Carolina death certificates - Page 1 |
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State Center for Health Statistics Statistical Brief No. 33 – June 2007 N. C. Department of Health and Human Services 1 Division of Public Health Underreporting of American Indian Race on North Carolina Death Certificates by Paul A. Buescher Statistical Brief No. 33 North Carolina Department of Health and Human Services Division of Public Health State Center for Health Statistics June 2007 Statistical Brief www. schs. state. nc. us/ SCHS/ Introduction Previous reports have shown that American Indian race is often not accurately reported on death certificates. For example, a 1999 study by Rosen-berg, et al. 1 indicated that death rates of American Indians are understated in official national publica-tions by approximately 21 percent. The denomina-tors of death rates, usually based on Census population data, tend to undercount minorities, which will inflate the death rates. Death certificates, used in the numerators, tend to undercount minori-ties, which will deflate the death rates. In the Rosenberg, et al. study, the net effect of these two opposing influences was that death rates for Ameri-can Indians were understated by 21 percent. The total American Indian/ Alaska Native ( AIAN) population of North Carolina according to the 2000 Census was 99,551 ( 1.2% of the state’s total popula-tion), counting those who reported American Indian/ Alaska Native alone as their race. Counting also those people who reported American Indian/ Alaska Native in combination with one or more other races, the AIAN population of North Carolina was 131,736. Among the American Indians in North Carolina are eight state- recognized tribes. One of these tribes, the Eastern Band of Cherokee, is a federally- recognized tribe, the only tribe residing on a federal reservation, and the only tribe in North Carolina served by the Indian Health Service of the United States Public Health Service. The Indian Health Service ( IHS) provides compre-hensive health care services to members of federal-ly- recognized American Indian tribes. To address the misclassification of American Indian race on death certificates, the IHS National Epidemiology Program has undertaken a comprehensive linkage of state- provided death certificates to IHS patient records. Goals of this project were to check the quality of the race data on death certificates and provide information for targeting state- level training for collection of better race data. The IHS has completed this death certificate linkage for about 15 states. This report presents the results for North Carolina. Methods North Carolina submitted death certificate records to the IHS for all deaths occurring in North Carolina for the period 1990- 2003, approximately 933,000 death records. Linkages between death certificates and IHS patient records were conducted by the IHS with probabilistic methods ( LinkPlus software) using name, date of birth, gender, Social Security number, and other identifiers. As mentioned above, only the Eastern Band of Cherokee in North Carolina is served by the Indian Health Service, so not all American Indian death certificates would be expected to match to the IHS patient records. Approximately 10 percent of Ameri-can Indians in North Carolina are members of the
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Full Text | State Center for Health Statistics Statistical Brief No. 33 – June 2007 N. C. Department of Health and Human Services 1 Division of Public Health Underreporting of American Indian Race on North Carolina Death Certificates by Paul A. Buescher Statistical Brief No. 33 North Carolina Department of Health and Human Services Division of Public Health State Center for Health Statistics June 2007 Statistical Brief www. schs. state. nc. us/ SCHS/ Introduction Previous reports have shown that American Indian race is often not accurately reported on death certificates. For example, a 1999 study by Rosen-berg, et al. 1 indicated that death rates of American Indians are understated in official national publica-tions by approximately 21 percent. The denomina-tors of death rates, usually based on Census population data, tend to undercount minorities, which will inflate the death rates. Death certificates, used in the numerators, tend to undercount minori-ties, which will deflate the death rates. In the Rosenberg, et al. study, the net effect of these two opposing influences was that death rates for Ameri-can Indians were understated by 21 percent. The total American Indian/ Alaska Native ( AIAN) population of North Carolina according to the 2000 Census was 99,551 ( 1.2% of the state’s total popula-tion), counting those who reported American Indian/ Alaska Native alone as their race. Counting also those people who reported American Indian/ Alaska Native in combination with one or more other races, the AIAN population of North Carolina was 131,736. Among the American Indians in North Carolina are eight state- recognized tribes. One of these tribes, the Eastern Band of Cherokee, is a federally- recognized tribe, the only tribe residing on a federal reservation, and the only tribe in North Carolina served by the Indian Health Service of the United States Public Health Service. The Indian Health Service ( IHS) provides compre-hensive health care services to members of federal-ly- recognized American Indian tribes. To address the misclassification of American Indian race on death certificates, the IHS National Epidemiology Program has undertaken a comprehensive linkage of state- provided death certificates to IHS patient records. Goals of this project were to check the quality of the race data on death certificates and provide information for targeting state- level training for collection of better race data. The IHS has completed this death certificate linkage for about 15 states. This report presents the results for North Carolina. Methods North Carolina submitted death certificate records to the IHS for all deaths occurring in North Carolina for the period 1990- 2003, approximately 933,000 death records. Linkages between death certificates and IHS patient records were conducted by the IHS with probabilistic methods ( LinkPlus software) using name, date of birth, gender, Social Security number, and other identifiers. As mentioned above, only the Eastern Band of Cherokee in North Carolina is served by the Indian Health Service, so not all American Indian death certificates would be expected to match to the IHS patient records. Approximately 10 percent of Ameri-can Indians in North Carolina are members of the |