Abstract
BackgroundPatient race in the Department of Veterans Affairs (VA) information system was previously recorded based on an administrative or clinical employee's observation. Since 2003, the VA started to collect self-reported race in compliance with a new federal guideline. We investigated the implications of this transition for using race/ethnicity data in multi-year trends in the VA and in other healthcare data systems that make the transition.MethodsAll unique users of VA healthcare services with self-reported race/ethnicity data in 2004 were compared with their prior observer-recorded race/ethnicity data from 1997 – 2002 (N = 988,277).ResultsIn 2004, only about 39% of all VA healthcare users reported race/ethnicity values other than "unknown" or "declined." Females reported race/ethnicity at a lower rate than males (27% vs. 40%; p < 0.001). Over 95% of observer-recorded data agreed with self-reported data. Compared with the patient self-reported data, the observer-recorded White and African American races were accurate for 98% (kappa = 0.89) and 94% (kappa = 0.93) individuals, respectively. Accuracy of observer-recorded races was much worse for other minority groups with kappa coefficients ranging between 0.38 for American Indian or Alaskan Natives and 0.79 for Hispanic Whites. When observer-recorded race/ethnicity values were reclassified into non-African American groups, they agreed with the self-reported data for 98% of all individuals (kappa = 0.93).ConclusionFor overall VA healthcare users, the agreement between observer-recorded and self-reported race/ethnicity was excellent and observer-recorded and self-reported data can be used together for multi-year trends without creating serious bias. However, this study also showed that observation was not a reliable method of race/ethnicity data collection for non-African American minorities and racial disparity might be underestimated if observer-recorded data are used due to systematic patterns of inaccurate race/ethnicity assignments.
Highlights
Patient race in the Department of Veterans Affairs (VA) information system was previously recorded based on an administrative or clinical employee's observation
The objective of this study is to examine the effect of this transition on the research use of race/ethnicity data for multi-year trends in the VA, focusing on how comparable race data collected under two different methods are and what the effect of bridging may be on different race categories when one try to map multiracial race values to the old single races for the same individuals
Valid self-reported race values were recorded for slightly less than 39% of them (1.9 million). Of those with valid race/ethnicity data in 2004, 79.2% identified themselves as Whites and 16.6% as African Americans, which together accounted for almost 96% of all Veterans Health Administration (VHA) users with valid race/ethnicity data
Summary
Since 2003, the VA started to collect self-reported race in compliance with a new federal guideline. We investigated the implications of this transition for using race/ethnicity data in multi-year trends in the VA and in other healthcare data systems that make the transition. In 1997, the Office of Management and Budget (OMB) released the revised standards for the collection of race and ethnicity known as Statistical Directive 15 that federal agencies were mandated to comply by January, 2003 [13]. The most significant changes in the new standards included self-identification as the preferred data collection method and the ability to report multiple races for an individual. For researchers who use data from multiple years for disease surveillance or tabulation of utilization and cost trends by race groups, this transition involved two methodological issues. The other was a more fundamental question of whether the prevalence of a particular disease, treatment, or outcomes would be comparable over time in race/ethnicity categories
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