How Mortality Data Fails Native Americans

By Kate Wheeling
from Pacific Standard

It’s no secret that the Indian Health Service, the federal agency tasked with providing health-care services to American Indians and Alaska Natives, is underfunded and overburdened; Native Americans are more likely to die from liver disease, diabetes, homicide, suicide, and respiratory diseases than the general population in the United States. But a new report from the Centers for Disease Control and Prevention finds yet another variance in the death certificates of Native Americans: Their race is often misclassified.

The study compared data of self-reported race classification from current population surveys and death certificates. Here are some highlights:

  • While race classification tended to be near perfect for white and black populations in the three decades between 1979 and 2011, only slightly more than half of American Indians or Alaska Natives were correctly identified as such on their death certificates over the same period.
  • Between 1999 and 2011, Hispanic and Asian or Pacific Islander populations experienced a decrease in misclassification, down to 3 percent from 5 and 7 percent, respectively. Over the same period, misclassification remained at 40 percent for American Indian and Alaska Native populations.
  • The majority of misclassified American Indians and Alaska Natives are erroneously classified as white.
  • The authors point to one common culprit for the errors: funeral directors, who typically fill out race and ethnicity information on death certificates. Directors should turn to the deceased’s family members for this information, the authors write, but too often rely on observation alone.
  • Two factors made errors less likely: a foreign country of birth, and certain geographic regions. Funeral directors must fill out a country of birth on death certificates, which could hint at the deceased’s actual ethnicity. And the greater the population of a particular race in a given region, the greater the likelihood that a funeral director will be familiar with the population, or belong to the minority group herself, increasing the odds of accurately recording a person’s race.

Mortality trend data can provide researchers and policymakers with valuable information on the health status of different populations, and can help pinpoint targets for intervention. But the data is only as valuable as its accuracy, and the large amount of misclassification of race on death certificates has the potential to undercut any insights gleaned from death records.

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