Journal Article

Racial Misclassification of American Indians and Alaska Natives by Indian Health Service Contract Health Service Delivery Area

Hoopes, Megan J., Wiggins, Charles L., Jim, Cheyenne C., Arias, Elizabeth, Jim, Melissa A., Johnson, Norman J., Seneca, Dean S.

2014

Overview

Objectives. We evaluated the racial misclassification of American Indians and Alaska Natives (AI/ANs) in cancer incidence and all-cause mortality data by Indian Health Service (IHS) Contract Health Service Delivery Area (CHSDA). Methods. We evaluated data from 3 sources: IHS-National Vital Statistics System (NVSS), IHS-National Program of Cancer Registries (NPCR)/Surveillance, Epidemiology and End Results (SEER) program, and National Longitudinal Mortality Study (NLMS). We calculated, within each data source, the sensitivity and classification ratios by sex, IHS region, and urban–rural classification by CHSDA county. Results. Sensitivity was significantly greater in CHSDA counties (IHS-NVSS: 83.6%; IHS-NPCR/SEER: 77.6%; NLMS: 68.8%) than non-CHSDA counties (IHS-NVSS: 54.8%; IHS-NPCR/SEER: 39.0%; NLMS: 28.3%). Classification ratios indicated less misclassification in CHSDA counties (IHS-NVSS: 1.20%; IHS-NPCR/SEER: 1.29%; NLMS: 1.18%) than non-CHSDA counties (IHS-NVSS: 1.82%; IHS-NPCR/SEER: 2.56%; NLMS: 1.81%). Race misclassification was less in rural counties and in regions with the greatest concentrations of AI/AN persons (Alaska, Southwest, and Northern Plains). Conclusions. Limiting presentation and analysis to CHSDA counties helped mitigate the effects of race misclassification of AI/AN persons, although a portion of the population was excluded.

• Publisher: American Public Health Association
• Subject: Alaska - epidemiology / Alaska - ethnology / American Indians / Biological and medical sciences / Cancer / Classification / Counties / Data / Epidemiology / Ethnicity / Female / General aspects / Health care / Health services / Hospitals / Humans / Incidence / Indians, North American - classification / Indians, North American - ethnology / Indigenous peoples / Inuits - classification / Inuits - ethnology / Longitudinal Studies / Male / Medical sciences / Methods / Miscellaneous / Mortality / National programmes / Native Americans / Native North Americans / Neoplasms - epidemiology / Neoplasms - ethnology / Population / Population Surveillance / Public health / Public Health Practice / Public health. Hygiene / Public health. Hygiene-occupational medicine / Race / Regions / Registration / Registries / Research and Practice / Rural communities / Rural urban differences / SEER Program / Service contracts / Surveillance / United States - epidemiology / United States Indian Health Service / Vital statistics