Methods for improving the quality and completeness of mortality data for American Indians and Alaska Natives

Am J Public Health. 2014 Jun;104 Suppl 3(Suppl 3):S286-94. doi: 10.2105/AJPH.2013.301716. Epub 2014 Apr 22.

Abstract

Objectives: We describe methods used to mitigate the effect of race misclassification in mortality records and the data sets used to improve mortality estimates for American Indians and Alaska Natives (AI/ANs).

Methods: We linked US National Death Index (NDI) records with Indian Health Service (IHS) registration records to identify AI/AN deaths misclassified as non-AI/AN deaths. Analyses excluded decedents of Hispanic origin and focused on Contract Health Service Delivery Area (CHSDA) counties. We compared death rates for AI/AN persons and Whites across 6 US regions.

Results: IHS registration records merged to 176,137 NDI records. Misclassification of AI/AN race in mortality data ranged from 6.3% in the Southwest to 35.6% in the Southern Plains. From 1999 to 2009, the all-cause death rate in CHSDA counties for AI/AN persons varied by geographic region and was 46% greater than that for Whites. Analyses for CHSDA counties resulted in higher death rates for AI/AN persons than in all counties combined.

Conclusions: Improving race classification among AI/AN decedents strengthens AI/AN mortality data, and analyzing deaths by geographic region can aid in planning, implementation, and evaluation of efforts to reduce health disparities in this population.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Alaska
  • Cause of Death
  • Child
  • Child, Preschool
  • Data Collection / standards*
  • Death Certificates
  • Female
  • Humans
  • Indians, North American / statistics & numerical data*
  • Infant
  • Inuit / statistics & numerical data*
  • Male
  • Middle Aged
  • Mortality / trends*
  • Population Surveillance
  • United States
  • United States Indian Health Service