1. Quality of Race and Hispanic Origin Reporting on Death Certificates in the US Elizabeth Arias, Ph.D. Mortality Statistics Branch Division of Vital Statistics National Center for Health Statistics

2. Outline The Problem Death rates for some race and Hispanic origin groups appear questionable Data Sources The Data Collection Process Evaluation of the Problem The National Longitudinal Mortality Study Self Reported Race/Ethnicity vs. Proxy Reported Race/Ethnicity Change in Data Quality over two decades: 1980s – 1990s Applications Use information to adjust observed mortality estimates Does adjustment have an effect on race/ethnic mortality disparities?

3. The Problem Numerator of rate Death Certificate=race and Hispanic origin identification is recorded by funeral director as per family member report or, often, as result of his/her observation of decedent. Denominator of rate Decennial Census=race and Hispanic origin identification is self-reported or reported by family/household member while individual is still alive.

4. Evaluation of Problem The National Longitudinal Mortality Study Current Population Surveys (CPS) & 1980 Census Data linked, using the NDI, to NCHS Mortality Data 26 Annual March CPS (1973, 1979-1998) and 1980 US Census sub-sample (~2.3 million records) CPS: National Sample of Households (60,000-80,000), Non- Institutionalized Population, 96% Response Rate Deaths Occurring between 1979-1998 (~253,000) Provides Ability to Compare Race and Hispanic Origin Reported by an Individual While Alive to What Was Reported on their Death Certificate upon Death.

5. Evaluation of Problem - Method Classification Ratios: Ratios of CPS race and Hispanic origin counts to death certificate counts for sample of identified decedents; basically, a ratio of row to column totals in a bivariate table of CPS (row) by Death Certificate (column) classification Estimate Classification Ratios for two time periods: 1980s and 1990s to assess change over time in quality Examples: White Ratio = Total CPS White / Total DC White Black Ratio = Total CPS Black / Total DC Black AIAN Ratio = Total CPS AIAN / Total DC AIAN API Ratio = Total CPS API / Total DC API

6. Classification Ratios Estimated by Selected Decedent Characteristics Information Derived From Death Certificate Sex Age (10-year age categories, exception first and last [0-14, 85+] Nativity (US Born, Foreign Born) Rural/Urban Status (rural or urban residence at time of death) Region of Residence (Northeast, Midwest, South, West residence at time of death) Co-ethnic Concentration (dichotomous variable indicating whether decedent died in county with high concentrations of co-ethnics)

7. Effect of Death Certificate Race and Hispanic Origin Misclassification on Mortality Measures Data pooled number of deaths 1999-2001 from NVSS bridged April 1, 2000 population census estimates for race groups Census 2000 Summary File 2 based on April 1, 2000 Census for Hispanic sub-groups Method Observed Age Specific Death Rages (ASDR i ) and Age Adjusted Death Rates(AADR) ASDR and AADR adjusted for age-specific classification ratios

8. Classification Ratios for Race Categories, by Period 1979-89 and 1990-98

9. Classification Ratios for Hispanic Categories, by Period 1979-89 and 1990-98

10. Ratios by Region for Race Categories, 1990- 98

11. Ratios by Co-ethnic Concentration, 1990-98

13. Effect of Correction on Age Adjusted Death Rates Observed and Corrected Age Adjusted Death Rates and Percentage Relative to White AIAN Observed  718.085% of White AADR Adjusted  943.2110% of White AADR API Observed  510.460% of White AADR Adjusted  540.164% of White AADR

14. Effect of Correction on Age Adjusted Death Rates Observed and Corrected Age Adjusted Death Rates and Percentage Relative to Non Hispanic White Hispanic Observed  672.179% Adjusted  707.183% Mexican Observed  753.788% Adjusted  746.388% Puerto Rican Observed  798.193% Adjusted  819.896%

15. Effect of Correction on Age Adjusted Death Rates Cuban Observed  692.881% Adjusted  694.682% Central/South American Observed  743.187% Adjusted  589.669% Other Hispanic Observed  381.845% Adjusted  650.776%

16. Summary 1) Agreement between self-report and DC report continues to be excellent for the white and black populations, but not for other groups 2) However, there has been some improvement over the 2 decades for most groups 3) This study revealed important relationships between decedents’ characteristics and the quality of race and ethnic reporting on DC AIAN and Hispanic decedents were significantly more likely to be correctly classified in areas of high co-ethnic concentration Foreign born Hispanic decedents were more likely to be correctly classified

17. Summary, Continued Death Rates are profoundly affected by the quality of reporting on DC Most glaring example is the case of AIAN mortality estimates The Hispanic Mortality Advantage (Hispanic Mortality Paradox) is barely affected Hispanic mortality remains almost 20% lower than that of Non-Hispanic whites Answer to the Hispanic Mortality Paradox lies elsewhere

18. Contact Information: Elizabeth Arias EArias@cdc.gov 301-458-4727EArias@cdc.gov