Comparison of Methods for Classifying Hispanic Ethnicity in a Population-based Cancer Registry

Abstract

The accuracy of ethnic classification can substantially affect ethnic-specific cancer statistics. In the Greater Bay Area Cancer Registry, which is part of the Surveillance, Epidemiology, and End Results (SEER) Program and of the statewide California Cancer Registry, Hispanic ethnicity is determined by medical record review and by matching to surname lists. This study compared these classification methods with self-report. Ethnic self-identification was obtained by surveying 1,154 area residents aged 20-89 years who were diagnosed with cancer in 1990 and were reported to the registry as being Hispanic or White non-Hispanic. Predictive value positive, sensitivity, and relative bias were used to assess the accuracy of Hispanic classification by medical record and surname. Among those persons classified as Hispanic by either or both of these sources, only two-thirds agreed (predictive value positive = 66%), and many self-identified Hispanics were classified incorrectly (sensitivity = 68%). Classification based on either medical record or surname alone had a lower sensitivity (59% and 61%, respectively) but a higher predictive value positive (77% and 70%, respectively). Ethnic classification by medical record alone resulted in an underestimate of Hispanic cancer cases and incidence rates. Bias was reduced when medical records and surnames were used together to classify cancer cases as Hispanic.

Seroepidemiology of hepatitis B virus infection: analysis of mass screening in Hawaii

“…A second limitation is the variable accuracy for our method of ethnic classification via surnames. The positive predictive value is comparable among Asian surname lists (83-93%) [29], but this value is low for Hispanic surnames (69%) [30]. Although this difference might have led to higher mis-classification of Hispanics in our sample, the impact is likely negligible due to the minute number of Hispanic surnames in the screening database.…”

“…For females, ethnicity was classified as indeterminate in the event of discrepant origins for first name and surname. Accuracy of surname classification, as measured by the positive predictive value, varies according to ethnic group and ranges from 61 to 96% [28][29][30][31][32][33]. To prevent miscalculation of prevalence, individuals with multiple screening records (i.e., persons tested more than once) were enrolled as single subjects and only the most recent age and HBsAg result were considered for the purposes of this study.…”

Existing data on breast cancer in African-American women

“…43,44 AA women appear to be classified accurately, at least in the Greater (San Francisco) Bay Area Cancer Registry, where preliminary analyses indicate that registry classification of AA race corresponds well with self-report. Of 452 women with breast cancer who were identified by the registry as AA, 96% also were self-identified as AA when they were interviewed for a multiethnic casecontrol study (unpublished data).…”

Annual report to the nation on the status of cancer, 1975–2003, featuring cancer among U.S. Hispanic/Latino populations

“…Direct and even self-identification of ethnicity is preferred, yet still inconsistent and under-reported on medical records and death certificates. [133][134][135][136][137][138] Indirect methods to enhance this information have been employed by cancer registries in the past, but with great regional variation in definition and application. 35,139 Efforts are in progress to improve the completeness of self-identification in medical records, but until that is achieved, all cancer registries can now use a standard method to enhance identification through NHIA v2, a method that enhances direct identification with indirect measures.…”