Determinants of Racial Misclassification in COVID-19 Mortality Data: The Role of Funeral Directors and Social Context

Kalweit, Andrew; Clark, Marc D.; Ishcomer-Aazami, Jamie

doi:10.17953/aicrj.44.3.kalweit_etal

Cited by 5 publications

(8 citation statements)

References 5 publications

(5 reference statements)

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“…The need for public health partnerships and resource provision with NA communities and organizations, including vaccine information and trusted messenger outreach efforts, supports previous findings from COVID-19 vaccine studies conducted with both NA and non-NA racial and ethnic minority populations [22] , [40] , [41] . Participants in our study articulated a need for increased unity in leadership and communication and expanded public health partnership, including financial and COVID-related resources and cultural tailoring, with NA networks to reach community members.…”

Section: Discussionsupporting

confidence: 74%

“…Racial misclassification of NAs from other racial or ethnic groups and data omission have been an ongoing barrier to correctly identifying health disparities and policy changes that address these disparities [37] . NAs have also been prone to racial misclassification and omission in COVID-19 mortality data due to misclassification of race by funeral directors [40] . Data on COVID-19, including vaccination rates, may be captured by various health data systems, including tribal, state, county, and city health agencies.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

A qualitative study of COVID-19 vaccine decision making among urban Native Americans

et al. 2022

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Section: Discussionsupporting

confidence: 74%

Section: Discussionmentioning

confidence: 99%

A qualitative study of COVID-19 vaccine decision making among urban Native Americans

et al. 2022

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“…Throughout the US, information on race and ethnicity recorded on the death certificate is less accurate for nonwhite populations than for whites, a disparity partly due to inadequate training (12)(13)(14)(15)(16)(17)(18). Kalweit et al conducted surveys and interviews with funeral directors across the US.…”

Section: Problems In Decedent Race and Ethnicity Classification And D...mentioning

confidence: 99%

“…Kalweit et al conducted surveys and interviews with funeral directors across the US. They found that there is inconsistent training for funeral directors, and funeral directors do not follow standard methods for collecting and coding “Hispanic origin” and tribal affiliation on death certificates ( 18 ). NC funeral directors shared in informal interviews that they frequently report their own perceptions of the decedent's race without consulting next of kin.…”

Section: Problems In Decedent Race and Ethnicity Classification And D...mentioning

confidence: 99%

“…While North Carolina (NC) has the largest AI/AN population in the eastern US, and NC's Asian, AI/AN, Hispanic, and "two or more race" Census-defined racial/ethnic groups have grown in the past 10 years, these groups represent a smaller proportion of the population than many other states (11). Previous research on racial and ethnic mortality disparities suggests that states with smaller non-white populations tend to have more incongruence between individuals' self-identified and death certificate recorded race and ethnicity (12)(13)(14)(15)(16)(17)(18). Further, a small number of misclassifications among small populations can have big impacts on mortality statistics (19).…”

mentioning

confidence: 99%

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Challenges with misclassification of American Indian/Alaska Native race and Hispanic ethnicity on death records in North Carolina occupational fatalities surveillance

McClure

Gartner²,

Bell³

et al. 2022

Front. Epidemiol.

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As frequently segregated and exploitative environments, workplaces are important sites in driving health and mortality disparities by race and ethnicity. Because many worksites are federally regulated, US workplaces also offer opportunities for effectively intervening to mitigate these disparities. Development of policies for worker safety and equity should be informed by evidence, including results from research studies that use death records and other sources of administrative data. North Carolina has a long history of Black/white disparities in work-related mortality and evidence of such disparities is emerging in Hispanic and American Indian/Alaska Native (AI/AN) worker populations. The size of Hispanic and AI/AN worker populations have increased in North Carolina over the last decade, and North Carolina has the largest AI/AN population in the eastern US. Previous research indicates that misidentification of Hispanic and AI/AN identities on death records can lead to underestimation of race/ethnicity-specific mortality rates. In this commentary, we describe problems and complexities involved in determining AI/AN and Hispanic identities from North Carolina death records. We provide specific examples of misidentification that are likely introducing bias to occupational mortality disparity documentation, and offer recommendations for improved data collection, analysis, and interpretation. Our primary recommendation is to build and maintain relationships with local community leadership, so that improvements in the ascertainment of race and ethnicity are grounded in the lived experience of workers from communities of color.

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Racial and Ethnic Disparities in Age-Specific All-Cause Mortality During the COVID-19 Pandemic

Faust,

Renton,

Bongiovanni

et al. 2024

JAMA Netw Open

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ImportanceThe end of the COVID-19 public health emergency (PHE) provides an opportunity to fully describe pandemic-associated racial and ethnic mortality disparities. Age-specific excess mortality differences have important downstream implications, especially in minoritized race and ethnicity populations.ObjectivesTo characterize overall and age-specific all-cause excess mortality by race and ethnicity during the COVID-19 PHE and assess whether measured differences reflected changes from prepandemic disparities.Design, Setting, and ParticipantsThis cross-sectional study analyzed data of all US residents and decedents during the COVID-19 PHE, aggregated by observed race and ethnicity (at time of death) and age. Statistical analysis was performed from March 2020 to May 2023.ExposuresCOVID-19 PHE period (March 2020 to May 2023).Main Outcomes and MeasuresAll-cause excess mortality (incident rates, observed-to-expected ratios) and all-cause mortality relative risks before and during the PHE.ResultsFor the COVID-19 PHE period, data for 10 643 433 death certificates were available; mean (SD) decedent age was 72.7 (17.9) years; 944 318 (8.9%) were Hispanic; 78 973 (0.7%) were non-Hispanic American Indian or Alaska Native; 288 680 (2.7%) were non-Hispanic Asian, 1 374 228 (12.9%) were non-Hispanic Black or African American, 52 905 (0.5%) were non-Hispanic more than 1 race, 15 135 (0.1%) were non-Hispanic Native Hawaiian or Other Pacific Islander, and 7 877 996 (74.1%) were non-Hispanic White. More than 1.38 million all-cause excess deaths (observed-to-expected ratio, 1.15 [95% CI, 1.12-1.18]) occurred, corresponding to approximately 23 million years of potential life lost (YPLL) during the pandemic. For the total population (all ages), the racial and ethnic groups with the highest observed-to-expected all-cause mortality ratios were the American Indian or Alaska Native (1.34 [95% CI, 1.31-1.37]) and Hispanic (1.31 [95% CI, 1.27-1.34]) populations. However, higher ratios were observed in the US population aged 25 to 64 years (1.20 [95% CI, 1.18-1.22]), greatest among the American Indian or Alaska Native (1.45 [95% CI, 1.42-1.48]), Hispanic (1.40 [95% CI, 1.38-1.42]), and Native Hawaiian or Other Pacific Islander (1.39 [95% CI, 1.34-1.44]) groups. In the total population aged younger than 25 years, the Black population accounted for 51.1% of excess mortality, despite representing 13.8% of the population. Had the rate of excess mortality observed among the White population been observed among the total population, more than 252 000 (18.3%) fewer excess deaths and more than 5.2 million (22.3%) fewer YPLL would have occurred.Conclusions and RelevanceIn this cross-sectional study of the US population during the COVID-19 PHE, excess mortality occurred in all racial and ethnic groups, with disparities affecting several minoritized populations. The greatest relative increases occurred in populations aged 25 to 64 years. Documented differences deviated from prepandemic disparities.

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Determinants of Racial Misclassification in COVID-19 Mortality Data: The Role of Funeral Directors and Social Context

Cited by 5 publications

References 5 publications

A qualitative study of COVID-19 vaccine decision making among urban Native Americans

A qualitative study of COVID-19 vaccine decision making among urban Native Americans

Challenges with misclassification of American Indian/Alaska Native race and Hispanic ethnicity on death records in North Carolina occupational fatalities surveillance

Racial and Ethnic Disparities in Age-Specific All-Cause Mortality During the COVID-19 Pandemic

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