Using advanced racial and ethnic identity demographics to improve surveillance of work‐related conditions in an occupational clinic setting

Abstract

Background: Although racial and ethnic identities are associated with a multitude of disparate medical outcomes, surveillance of these subpopulations in the occupational clinic setting could benefit enormously from a more detailed and nuanced recognition of racial and ethnic identity. Methods:The research group designed a brief questionnaire to capture several dimensions of this identity and collected data from patients seen for work-related conditions in four occupational medicine clinics from May 2019 through March 2020. Responses were used to calculate the sensitivity and specificity of extant racial/ethnic identity data within our electronic health records system, and were compared to participants' self-reported industry and occupation, coded according to North American Industry Classification System and Standard Occupational Classification System listings.Results: Our questionnaire permitted collection of data that defined our patients' specific racial/ethnic identity with far greater detail, identified patients with multiple ethnic identities, and elicited their preferred language. Response rate was excellent (94.2%, n = 773). Non-White participants frequently selected a racial/ethnic subcategory (78.1%-92.2%). Using our race/ethnicity data as a referent, the electronic health record (EHR) had a high specificity (>87.1%), widely variable sensitivity (11.8%-82.2%), and poorer response rates (75.1% for race, 82.5% for ethnicity, as compared to 93.8% with our questionnaire). Additional analyses revealed some industries and occupations disproportionately populated by patients of particular racial/ethnic identities.

Asking MultiCrit Questions: A Reflexive and Critical Framework to Promote Health Data Equity for the Multiracial Population

“…But racism may operate differently depending on the targeted group (e.g., via anti‐Blackness, xenophobia, colorism, or the model minority stereotype), and Multiracial people may additionally experience monoracism : the variant of racism that privileges monoracial identities and erases Multiracial people's experiences 25,62 . Institutional monoracism has shaped our strong preference to conceptualize race using mutually exclusive categories 62 ; it can look like electronic medical record systems that (in the 2020s, no less) are still not programmed to handle multiple race selections, 64–66 monoracially organized student recruitment and retention centers on college campuses, 62,67,68 or peer‐reviewed studies that pathologize—rather than contextualize—the impact of Multiracial identity on health 27,28,69–71 . Everyday monoracism may manifest as Multiracial microaggressions , which can look like Multiracial adolescents having to defend the “authenticity” of their racial identities to monoracial relatives or peers, 50,72–74 Multiracial people allowing others to view them as monoracial to avoid confusing or drawing unwanted attention, 62 travel security agents flagging parents of Multiracial children as suspected sex traffickers, 75 health care professionals making inappropriate assumptions or comments about a Multiracial patient's racial background, 28,76 or fetishization and exotification of a Multiracial person's physical appearances 25,73 .…”