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