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

2. Highlights Evaluation of Race and Hispanic Origin Reporting on the US Death Certificate Evaluation of Race and Hispanic Origin Reporting on the US Death Certificate The Problem: death rates for some race and Hispanic origin groups are too low The Problem: death rates for some race and Hispanic origin groups are too low The Data Collection Process The Data Collection Process The National Longitudinal Mortality Study The National Longitudinal Mortality Study Self Reported Race/Ethnicity vs. Proxy Reported Race/Ethnicity Self Reported Race/Ethnicity vs. Proxy Reported Race/Ethnicity Future Applications Future Applications Adjusted Death Rates Adjusted Death Rates Adjusted Life Expectancy Estimates Adjusted Life Expectancy Estimates

3. Data Source for US Death Rates Numerator of rate 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. 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 Denominator of rate Decennial Census=race and Hispanic origin identification is self-reported or reported by family/household member while individual is still alive. Decennial Census=race and Hispanic origin identification is self-reported or reported by family/household member while individual is still alive.

4. Evaluation of Race and Hispanic Origin Reporting on the US Death Certificate The National Longitudinal Mortality Study The National Longitudinal Mortality Study Current Population Surveys (CPS) & 1980 Census Data linked, using the NDI, to NCHS Mortality Data Current Population Surveys (CPS) & 1980 Census Data linked, using the NDI, to NCHS Mortality Data 25 Annual March CPS (1973, 1979-1998) and 1980 US Census sub-sample (~2.4 million persons) 25 Annual March CPS (1973, 1979-1998) and 1980 US Census sub-sample (~2.4 million persons) CPS: National Sample of Households (60,000-80,000), Non- Institutionalized Population, 96% Response Rate CPS: National Sample of Households (60,000-80,000), Non- Institutionalized Population, 96% Response Rate Deaths Occurring between 1979-1998 (~252,000) Deaths Occurring between 1979-1998 (~252,000) Provides Ability to Compare Race and Hispanic Origin Reported by an Individual While Alive to What Was Reported on their Death Certificate upon Death. 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 Technique Ratios of Race and Hispanic Origin self report to Race and Hispanic Origin to proxy report. Ratios are constructed by dividing the aggregate number of CPS reported race/Hispanic origin categories (self-identified) by the number of Death Certificate race/Hispanic origin categories (proxy identified) Ratios of Race and Hispanic Origin self report to Race and Hispanic Origin to proxy report. Ratios are constructed by dividing the aggregate number of CPS reported race/Hispanic origin categories (self-identified) by the number of Death Certificate race/Hispanic origin categories (proxy identified) Example: Example: White Ratio = Total CPS White / Total DC White White Ratio = Total CPS White / Total DC White Black Ratio = Total CPS Black / Total DC Black Black Ratio = Total CPS Black / Total DC Black AIAN Ratio = Total CPS AIAN / Total DC AIAN AIAN Ratio = Total CPS AIAN / Total DC AIAN API Ratio = Total CPS API / Total DC API API Ratio = Total CPS API / Total DC API Percent Agreement between self selected race and Hispanic origin and proxy selected race and Hispanic origin Percent Agreement between self selected race and Hispanic origin and proxy selected race and Hispanic origin Example: Example: Of all individuals who selected, say, white on CPS, what percentage were actually coded as white on the Death Certificate. Of all individuals who selected, say, white on CPS, what percentage were actually coded as white on the Death Certificate.

6. Sample Size Race1979-981979-891990-98 Race1979-981979-891990-98 White172,18064,600107,580 White172,18064,600107,580 Black 19,719 7,454 12,265 Black 19,719 7,454 12,265 AIAN 1,437 510 927 AIAN 1,437 510 927 API 2,044 661 1,383 API 2,044 661 1,383

7. Sample Size Hispanic 1979-981979-891990-98 Hispanic 1979-981979-891990-98 Mexican4,4521,2833,169 Mexican4,4521,2833,169 PuertoRican 760 207 553 PuertoRican 760 207 553 Cuban 700 104 596 Cuban 700 104 596 C/SAmerican 352 90 262 C/SAmerican 352 90 262 OtherHisp 1,338 2821, 056 OtherHisp 1,338 2821, 056 Total 9,5681,9667,602 Total 9,5681,9667,602

8. Factors Affecting Race and Hispanic Origin Reporting on the US Death Certificate Sex Sex Age Age Nativity (US Born, Foreign Born) Nativity (US Born, Foreign Born) Rural/Urban Status Rural/Urban Status Region of Residence Region of Residence

9. Ratios for Race Categories, by Period 1979-89, 1990-98

10. Ratios for Hispanic Origin Categories, by Period 1979-89, 1990-98

11. Ratios for Hispanic Origin Categories, by Period: 1979-89 & 1990-98

12. Ratios by Sex for Race Categories, 1990-98

13. Ratios by Sex for Hispanic Origin Categories, 1990-98

14. Ratios by Age for Race Categories, 1990-98

15. Ratios by Age for Hispanic Origin Categories, 1990-98

16. Ratios by Nativity for Race Categories, 1990-98

17. Ratios by Nativity for Hispanic Origin Categories, 1990-98

18. Ratios by Urban/Rural Residence for Race Categories, 1990-98

19. Ratio of Urban/Rural Status for Hispanic Origin Categories, 1990-98

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

21. Ratios by Region for Hispanic Origin Categories, 1990-98

22. Hispanic Origin Distribution on Death Certificate Among Self-Identified Hispanics, 1990-98

23. Hispanic Origin Distribution on Death Certificate Among Self-Identified Mexicans, 1990-98

24. Hispanic Origin Distribution on Death Certificate Among Self-Identified Puerto Ricans, 1990-98

25. Hispanic Origin Distribution on Death Certificate Among Self-Identified Cubans, 1990-98

26. Hispanic Origin Distribution on Death Certificate Among Self-Identified C/S Americans, 1990-98

27. Hispanic Origin Distribution on Death Certificate Among Self-Identified AIANs, 1990-98

29. Summary Reporting appears to have improved over time for some groups: Reporting appears to have improved over time for some groups: AIAN AIAN API API Hispanics Hispanics There is still considerable variation within the Hispanic community There is still considerable variation within the Hispanic community There is still considerable variation by region of residence and nativity There is still considerable variation by region of residence and nativity AIAN AIAN API API Hispanics Hispanics