Journal
HEALTH SERVICES RESEARCH
Volume 50, Issue -, Pages 1390-1402Publisher
WILEY
DOI: 10.1111/1475-6773.12331
Keywords
Hospital discharge; hospitalizations; data quality; racial misclassification; disparities; American Indian; Alaska Native; Pacific Northwest; Oregon; Washington
Funding
- Northwest Portland Area Indian Health Board
- Agency for Healthcare Research and Quality [R01HS019972]
- Office of Minority Health [AIAMP120012]
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ObjectiveTo evaluate and adjust for American Indian and Alaska Native (AI/AN) racial misclassification in two hospital discharge datasets in the Pacific Northwest. Data Sources/Study SettingOregon (2010-2011) and Washington (2011) hospital discharge datasets were linked with the Northwest Tribal Registry (NTR), a registry of AI/AN individuals who accessed services at Indian health facilities in the Northwest. Study DesignRecord linkage was used to match state hospital records to the NTR. A state record was considered misclassified if it matched the NTR and was coded as non-AI/AN or missing race data. Effect of misclassification was evaluated by comparing prelinkage and postlinkage, age-adjusted hospital discharge rates. Data Collection/Extraction MethodsResearchers used Link Plus 2.0 software (Atlanta, GA, USA) for linkages and SAS 9.4 (Cary, NC, USA) for statistical analyses. Principal FindingsIn Oregon, 55.4 percent of matching records were misclassified (66.5 percent miscoded white, and 22.1 percent were missing race information). In Washington, 44.9 percent of matching records were misclassified (61.8 percent miscoded white, and 32.7 percent were missing race information). Linkage increased ascertainment of AI/AN hospitalizations by 31.8 percent in Oregon and 33.9 percent in Washington. Linkage increased the rate ratio (RR) for AI/AN hospitalizations in comparison to non-Hispanic whites (NHW) from 0.81 to 1.07 in Oregon, and from 1.21 to 1.62 in Washington. ConclusionCorrection of race in hospital discharge datasets through linkage with a reference file of known AI/AN individuals is an important first step before analytic research on AI/AN health care in the Pacific Northwest can be accomplished with administrative datasets.
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