Blurred lines: racial misclassification in death certificates in Brazil.

Abstract

To analyze the agreement between self-reported race and race reported on death certificates for older (≥ 60years) residents of São Paulo, Brazil (from 2000 to 2016) and to estimate weights to correct mortality data by race. We used data from the Health, Well-Being and Aging Study (SABE) and from Brazil's Mortality Information System. Misclassification was identified by comparing individual self-reported race with the corresponding race on the death certificate (n = 1012). Racial agreement was analyzed by performing sensitivity and Cohen's Kappa tests. Multinomial logistic regressions were adjusted to identify characteristics associated with misclassification. Correction weights were applied to race-specific mortality rates. Total racial misclassification was 17.3% (13.1% corresponded to whitening, and 4.2% to blackening). Racial misclassification was higher for self-reported pardos/mixed (63.5%), followed by blacks (42.6%). Official vital statistics suggest highest elderly mortality rates for whites, but after applying correction weights, black individuals had the highest rate (45.85/1000 population), followed by pardos/mixed (42.30/1000 population) and whites (37.91/1000 population). Official Brazilian data on race-specific mortality rates may be severely misclassified, resulting in biased estimates of racial inequalities.