用于监测 COVID-19 结局和疫苗接种覆盖情况的种族和民族分组替代方法。
Alternative Methods for Grouping Race and Ethnicity to Monitor COVID-19 Outcomes and Vaccination Coverage.
机构信息
CDC COVID-19 Response Team.
出版信息
MMWR Morb Mortal Wkly Rep. 2021 Aug 13;70(32):1075-1080. doi: 10.15585/mmwr.mm7032a2.
Population-based analyses of COVID-19 data, by race and ethnicity can identify and monitor disparities in COVID-19 outcomes and vaccination coverage. CDC recommends that information about race and ethnicity be collected to identify disparities and ensure equitable access to protective measures such as vaccines; however, this information is often missing in COVID-19 data reported to CDC. Baseline data collection requirements of the Office of Management and Budget's Standards for the Classification of Federal Data on Race and Ethnicity (Statistical Policy Directive No. 15) include two ethnicity categories and a minimum of five race categories (1). Using available COVID-19 case and vaccination data, CDC compared the current method for grouping persons by race and ethnicity, which prioritizes ethnicity (in alignment with the policy directive), with two alternative methods (methods A and B) that used race information when ethnicity information was missing. Method A assumed non-Hispanic ethnicity when ethnicity data were unknown or missing and used the same population groupings (denominators) for rate calculations as the current method (Hispanic persons for the Hispanic group and race category and non-Hispanic persons for the different racial groups). Method B grouped persons into ethnicity and race categories that are not mutually exclusive, unlike the current method and method A. Denominators for rate calculations using method B were Hispanic persons for the Hispanic group and persons of Hispanic or non-Hispanic ethnicity for the different racial groups. Compared with the current method, the alternative methods resulted in higher counts of COVID-19 cases and fully vaccinated persons across race categories (American Indian or Alaska Native [AI/AN], Asian, Black or African American [Black], Native Hawaiian or Other Pacific Islander [NH/PI], and White persons). When method B was used, the largest relative increase in cases (58.5%) was among AI/AN persons and the largest relative increase in the number of those fully vaccinated persons was among NH/PI persons (51.6%). Compared with the current method, method A resulted in higher cumulative incidence and vaccination coverage rates for the five racial groups. Method B resulted in decreasing cumulative incidence rates for two groups (AI/AN and NH/PI persons) and decreasing cumulative vaccination coverage rates for AI/AN persons. The rate ratio for having a case of COVID-19 by racial and ethnic group compared with that for White persons varied by method but was <1 for Asian persons and >1 for other groups across all three methods. The likelihood of being fully vaccinated was highest among NH/PI persons across all three methods. This analysis demonstrates that alternative methods for analyzing race and ethnicity data when data are incomplete can lead to different conclusions about disparities. These methods have limitations, however, and warrant further examination of potential bias and consultation with experts to identify additional methods for analyzing and tracking disparities when race and ethnicity data are incomplete.
基于人群的 COVID-19 数据分析,按种族和族裔进行分析,可以确定和监测 COVID-19 结果和疫苗接种覆盖方面的差异。疾病预防控制中心建议收集有关种族和族裔的信息,以识别差异并确保公平获得疫苗等保护措施;然而,向疾病预防控制中心报告的 COVID-19 数据中经常缺少此类信息。行政管理和预算办公室的《联邦种族和族裔数据分类标准》(统计政策指令 15)的基线数据收集要求包括两个族裔类别和至少五个种族类别(1)。使用现有的 COVID-19 病例和疫苗接种数据,疾病预防控制中心比较了目前按种族和族裔划分人群的方法,该方法优先考虑族裔(与政策指令一致),同时还比较了两种替代方法(方法 A 和 B),这两种方法在族裔信息缺失时使用种族信息。方法 A 在族裔数据未知或缺失时假设为非西班牙裔,并使用与当前方法相同的人群分组(率计算的分母)(西班牙裔人群为西班牙裔群体,不同种族群体的非西班牙裔人群)。方法 B 将人群分为非互斥的族裔和种族类别,与当前方法和方法 A 不同。使用方法 B 进行率计算的分母是西班牙裔群体的西班牙裔人群和具有西班牙裔或非西班牙裔族裔的不同种族群体的人群。与当前方法相比,替代方法导致不同种族类别中的 COVID-19 病例和完全接种疫苗的人数增加(美国印第安人或阿拉斯加原住民[AI/AN]、亚洲人、黑人或非裔美国人[黑人]、夏威夷原住民或其他太平洋岛民[NH/PI]和白人)。当使用方法 B 时,AI/AN 人群的病例相对增加最多(58.5%),而 NH/PI 人群的完全接种疫苗人数的相对增加最多(51.6%)。与当前方法相比,方法 A 导致五个种族群体的累积发病率和疫苗接种覆盖率更高。方法 B 导致两个群体(AI/AN 和 NH/PI 人群)的累积发病率下降,AI/AN 人群的累积疫苗接种覆盖率下降。与白人相比,按种族和族裔群体的 COVID-19 病例发生率的比率因方法而异,但在所有三种方法中,亚洲人<1,其他群体>1。在所有三种方法中,NH/PI 人群完全接种疫苗的可能性最高。本分析表明,当数据不完整时,分析种族和族裔数据的替代方法可能会导致关于差异的不同结论。然而,这些方法存在局限性,需要进一步检查潜在的偏差,并咨询专家,以确定在种族和族裔数据不完整时分析和跟踪差异的其他方法。
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