Eliminating Health Disparities Measurement and Data Needs (2004) / Chapter Skim
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5 State-Based Collection of Data on Race, Ethnicity, Socioeconomic Position, and Acculturation and Language Use
5 State-Based Collection of Data on Race, Ethnicity, Socioeconomic Position, and Acculturation and Language Use
Pages 83-98
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From page 83... ...
The systems reviewed are vital statistics birth and death records, hospital discharge abstracts, cancer registries, health interview surveys, and Medicaid and the State Children's Health Insurance Program (SCHIP) , with examples of how these data have been used to understand disparities in health and health care.
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From page 84... ...
(National Center for Health Statistics, 2003) ; and Hawaiians have a lower rate of early prenatal care than other Asian and Pacific Islanders (79.1 percent, compared with 90.1 percent for mothers of Japanese descent, 87.0 percent for mothers of Chinese descent, 85.0 percent for mothers of Filipino descent, and 82.7 percent for mothers of other Asian or Pacific Islander descent)
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From page 85... ...
For example, states use vital statistics for prenatal care interventions and infant mortality reduction. Information for birth certificates is recorded at the birth of an infant by a health care professional, and information for death certificates is usually collected by a funeral home director.
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From page 86... ...
Standard Certificates White Black or African American American Indian or Alaska Native (name of the enrolled or principal tribe) Asian Indian Chinese Filipino Japanese Korean Vietnamese Other Asian (specify)
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From page 87... ...
However, the IMRs for blacks, non-Hispanic blacks, and other race groups increase compared to IMRs calculated using standard race definitions. A similarly structured study in the state of Washington found that 61 percent of infants who died in the first year of life and were recorded as being of American Indian or Alaska Native descent on their birth records were coded as American Indian or Alaska Native at death (Frost and Shy, 1980)
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From page 88... ...
The government purchases the state hospital discharge data from state and private data organizations and hospital associations to create a national data set, the Healthcare Cost and Utilization Project (HCUP) maintained by the Agency for Healthcare Research and Quality (AHRQ)
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From page 89... ...
program or the CDC's National Program of Cancer Registries (NPCR) .2 Data come from hospitals, physicians' offices, and laboratories and are provided to a central statewide registry, or, in the case of six SEER metropolitan sites and other SEER rural or special population sites, to local registries.
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From page 90... ...
The state of California in 2001 sponsored the California Health Interview Survey, which collected extensive health-related data on individuals-demographic information, health status, health insurance coverage, eligibility and participation in public coverage and assistance programs, utilization of health services, and access to care. These data have been used, for example, to show that racial and ethnic differences exist in the percent of adults with diabetes in California who monitor their glucose levels at least once per day and in percentages for those with different health insurance 4It is not clear if the racial and ethnic data format requirements were the reason states were not certified.
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From page 91... ...
King County (Seattle) , Washington, conducted a survey modeled on the Behavioral Risk Factor Surveillance System called the Ethnicity and Health Survey, which oversampled seven racial and ethnic minority groups, including five different Asian ethnic groups with high concentrations in the Seattle area (Smyser, Krieger, and Solet, 1999)
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From page 92... ...
States do have the option, however, of reporting race and Hispanic ethnicity in separate questions, indicating whether an enrollee is white or not, black or African American or not, American Indian/Alaska Native or not, Native Hawaiian or Other Pacific Islander or not, and Hispanic or not.6 Thus, if states record this information separately, information about Hispanic ethnicity can be obtained separately from racial status in the MSIS. In addition, if a state collects this information, the MSIS data include an option for multiracial status and so multiple races can be identified as well.
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From page 93... ...
There are no requirements to report individual data for SCHIP, although states are required to report aggregate information to the federal government. If states use SCHIP funds to expand their Medicaid programs, then individual enrollment data (including racial and ethnic data)
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From page 94... ...
Data from hospital discharge abstracts and from cancer registries are important especially for research on disparities in health care, an area where federal sources of data are lacking. Data from Medicaid and SCHIP, if they can be linked with claims data as the MSIS hopes to do, can 8While mandates may increase the completeness of these records, differences in the accuracy of data reported under mandatory versus nonmandatory systems have not been examined.
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From page 95... ...
This is probably in part because the settings in which data from vital records, hospital discharge abstracts, and cancer registries are collected are often not well suited for collecting extensive amounts of data, especially for concepts as difficult to measure as economic resources and degree of acculturation. However, some simple measures of SEP, such as education level or occupation, could be collected fairly easily in these data systems.
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From page 96... ...
The collection of racial and ethnic data is beneficial only to the extent that the data are used to improve quality of care, administration of state programs, and the broad health status of state populations. It is important for key stakeholders in the data collection process to see that the data are being used for important and appropriate purposes.
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From page 97... ...
To address gaps in coverage in many administration records, some states link public health data sets. For example, researchers from the New Hampshire State Department of Health and Human Services link data from the New Hampshire State Cancer Registry to state hospital discharge data (Taylor and Liu, 2003)
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From page 98... ...
Although none of these linkages is done specifically to fill in gaps in information on race, ethnicity, SEP, or acculturation and language use, similar linkages could be attempted to use the strengths of some data sources in measuring these characteristics to supplement what is not collected in other data sources. In order to meet the data collection and analysis needs for measuring and reducing disparities, the public and private sectors will need to coordinate efforts to develop state data and research agendas and design effective interventions.
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