1. Validity of ethnicity recording in the maternity clinical administration system in NHS Lothian, Scotland Dr Fatim Lakha Mr Andrew Massie Dr Dermot Gorman

2. Outline of presentation Background Aims Methods Classification Results Conclusions and next steps

3. Background Health experiences, care & management of different ethnic groups vary Reduction in inequalities is a priority –2010 Equality Act (UK) –2010 Healthcare Quality Strategy Scotland NHS is striving to collect routine ethnicity data in a standardised way The accuracy of this data recording has not been validated to date

4. Aims To evaluate the completeness & validity of ethnicity recording in the maternity administration system To assess if could describe use/need for interpretation services by ethnic group alone and/or in conjunction with other data

5. Annual completion rates of ethnicity data in the maternity clinical administration system NHS Lothian (maternity Trak) YearEthnicity recording completion rate 200952% 201086% 201193% 2012 2013 2014 (to end Oct) 97%

6. Methods (1) Maternity TRAK – records self assigned ethnicity plus ‘preferred language and need for an interpreter – data collected by a midwife in early pregnancy National Records Scotland records for all live births in 2012 (birth certificates) – mother’s country of birth – on official registration of the birth The two datasets were linked

7. Methods (2) For both datasets each individual record was assigned to one of 13 classification groups Sensitivity, specificity, PPV and NPV calculated Explored use/need for interpreter by ethnicity alone and with preferred language.

8. Geographical classification groups African Australasian Caribbean East Asian Eastern Europe European other Middle East North American South American South Asian UK Other Refusal/unknown

9. Results

10. Validity of Maternity TRAK ethnicity data

11. Explaining the reduced sensitivity of ethnicity to ‘country of birth’

12. Validity of Maternity TRAK ethnicity data

13. How does TRAK ethnicity match to NRS country of birth?

14. Can ethnicity be a guide to interpreter requirements?

15. Preferred language and interpreter requirement for self-reported ‘South Asians’

16. Preferred language and interpreter requirement for self-reported ‘Eastern Europeans’ (n=611)

17. Strengths 1.High levels of completeness 2.Accurate recording by staff – staff training etc has helped and mandatory now so very helpful 3.able to classify individuals into 13 classification groups thus then easy to compare NRS with mat trak 4.NRS registration is mandatory and the MCOB is 100% Limitations 1.NRS data incomplete for December - This led to reduced matching and sample size. 2.Too many ethnicity options in maternity trak

18. Conclusions Ethnicity data is very completely & accurately recorded by maternity staff Differences in ‘meaning’ between terms ethnicity/nationality/CoB must be understood & interpreted in light of known national migration patterns Ethnicity & CoB data are important in examining access and equity of service provision – which is best to use depends on the subject and may require additional data such as preferred language.

19. Next steps Disseminate findings and link with the Edinburgh Health and Ethnicity research group Consider a simplified menu of ethnicity choices on maternity Trak Undertake further work to address concerns that needs for interpretation/translation are not being adequately met Maternity trak ethnicity is being used to: Interpreter provision in maternity care Ensure equity of provision of an intervention to improve access to postnatal contraceptive services Audit of FGM care

20. Acknowledgements Niall Blackie for supplying the 2012 maternity TRAK data NRS for supplying the 2012 birth registrations Dr Vittal Katikireddi Ms Echo Lian for linking the two datasets Additional Needs and Diversity Information Task Force (ANDI TF) Chair Prof Bhopal – has led improvements in Lothian’s ethnicity recording

21. Births by ethnic group over time