1991 年至 2015 年期间，俄克拉荷马州美洲印第安人/阿拉斯加原住民的死亡率记录中的种族分类错误。
Racial Misclassification in Mortality Records Among American Indians/Alaska Natives in Oklahoma From 1991 to 2015.
机构信息
Oklahoma Area Tribal Epidemiology Center, Southern Plains Tribal Health Board, Oklahoma City, Oklahoma (Mr Dougherty); Department of Biostatistics and Epidemiology, Hudson College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma (Drs Janitz, Williams, Martinez, and Campbell); Division of Research and Public Health, Chickasaw Nation Department of Health, Ada, Oklahoma (Mr Peercy); Choctaw Nation Health Services Authority, Choctaw Nation of Oklahoma, Idabel, Oklahoma (Mr Wharton); and Office of the Clinical Director, Division of Intramural Research, National Heart, Lung, and Blood Institute (NHLBI), National Institutes of Health, Bethesda, Maryland (Ms Erb-Alvarez).
出版信息
J Public Health Manag Pract. 2019 Sep/Oct;25 Suppl 5, Tribal Epidemiology Centers: Advancing Public Health in Indian Country for Over 20 Years(Suppl 5 TRIBAL EPIDEMIOLOGY CENTERS ADVANCING PUBLIC HEALTH IN INDIAN COUNTRY FOR OVER 20 YEARS):S36-S43. doi: 10.1097/PHH.0000000000001019.
OBJECTIVE
The primary purpose of this study was to compare age-adjusted mortality rates before and after linkage with Indian Health Service records, adjusting for racial misclassification. We focused on differences in racial misclassification by gender, age, geographic differences, substate planning districts, and cause of death. Our secondary purpose was to evaluate time trends in misclassification from 1991 to 2015.
DESIGN
Retrospective, descriptive study.
SETTING
Oklahoma.
PARTICIPANTS
Persons contained in the Oklahoma State Health Department Vital Records.
MAIN OUTCOME MEASURES
To evaluate the age-adjusted mortality ratio pre- and post-Indian Health Service record linkage (misclassification rate ratio) and to evaluate the overall trend of racial misclassification on mortality records measured through annual percent change (APC) and average annual percent change (AAPC).
RESULTS
We identified 2 stable trends of racial misclassification upon death for American Indians/Alaska Natives (AI/ANs) from 1991 to 2001 (APC: -0.2%; 95% confidence interval: -1.4% to 1.0%) and from 2001 to 2005 (APC: -6.9%; 95% confidence interval: -13.7% to 0.4%). However, the trend identified from 2005 to 2015 decreased significantly (APC: -1.4%; 95% confidence interval: -2.5% to -0.2%). For the last 5 years available (2011-2015), the racial misclassification adjustment resulted in higher mortality rates for AI/ANs reflecting an increase from 1008 per 100 000 to 1305 per 100 000 with the linkage process. There were an estimated 3939 AI/ANs in Oklahoma who were misclassified as another race upon death in those 5 years, resulting in an underestimation of actual AI/AN deaths by nearly 29%.
CONCLUSIONS
An important result of this study is that misclassification is improving; however, this effort needs to be maintained and further improved. Continued linkage efforts and public access to linked data are essential throughout the United States to better understand the burden of disease in the AI/AN population.
目的
本研究的主要目的是比较与印第安人健康服务记录链接前后的年龄调整死亡率，同时调整种族分类错误。我们专注于按性别、年龄、地理差异、州以下规划区和死因分类的种族分类错误差异。我们的次要目的是评估 1991 年至 2015 年期间分类错误的时间趋势。
设计
回顾性描述性研究。
地点
俄克拉荷马州。
参与者
俄克拉荷马州卫生部生命记录中的人员。
主要观察指标
评估印第安人健康服务记录链接前后的年龄调整死亡率比值（分类错误率比值），并通过年度百分比变化（APC）和平均年度百分比变化（AAPC）评估死亡率记录中种族分类错误的总体趋势。
结果
我们发现，1991 年至 2001 年（APC：-0.2%；95%置信区间：-1.4%至 1.0%）和 2001 年至 2005 年（APC：-6.9%；95%置信区间：-13.7%至 0.4%），美洲印第安人/阿拉斯加原住民（AI/ANs）在死亡时存在 2 种稳定的种族分类错误趋势。然而，2005 年至 2015 年期间确定的趋势显著下降（APC：-1.4%；95%置信区间：-2.5%至-0.2%）。在最后 5 年（2011-2015 年），种族分类错误调整导致 AI/AN 的死亡率更高，反映出链接过程中从每 100000 人 1008 人增加到每 100000 人 1305 人。在这 5 年中，估计有 3939 名 AI/AN 人在死亡时被错误分类为其他种族，导致实际 AI/AN 死亡人数低估了近 29%。
结论
这项研究的一个重要结果是，分类错误正在改善；然而，需要保持并进一步改进这一努力。在美国各地，继续进行链接工作并使公众能够访问链接数据，对于更好地了解美洲原住民人口的疾病负担至关重要。
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