Racial misclassification of American Indians and Alaska Natives by Indian Health Service Contract Health Service Delivery Area

Am J Public Health. 2014 Jun;104 Suppl 3(Suppl 3):S295-302. doi: 10.2105/AJPH.2014.301933. Epub 2014 Apr 22.


Objectives: We evaluated the racial misclassification of American Indians and Alaska Natives (AI/ANs) in cancer incidence and all-cause mortality data by Indian Health Service (IHS) Contract Health Service Delivery Area (CHSDA).

Methods: We evaluated data from 3 sources: IHS-National Vital Statistics System (NVSS), IHS-National Program of Cancer Registries (NPCR)/Surveillance, Epidemiology and End Results (SEER) program, and National Longitudinal Mortality Study (NLMS). We calculated, within each data source, the sensitivity and classification ratios by sex, IHS region, and urban-rural classification by CHSDA county.

Results: Sensitivity was significantly greater in CHSDA counties (IHS-NVSS: 83.6%; IHS-NPCR/SEER: 77.6%; NLMS: 68.8%) than non-CHSDA counties (IHS-NVSS: 54.8%; IHS-NPCR/SEER: 39.0%; NLMS: 28.3%). Classification ratios indicated less misclassification in CHSDA counties (IHS-NVSS: 1.20%; IHS-NPCR/SEER: 1.29%; NLMS: 1.18%) than non-CHSDA counties (IHS-NVSS: 1.82%; IHS-NPCR/SEER: 2.56%; NLMS: 1.81%). Race misclassification was less in rural counties and in regions with the greatest concentrations of AI/AN persons (Alaska, Southwest, and Northern Plains).

Conclusions: Limiting presentation and analysis to CHSDA counties helped mitigate the effects of race misclassification of AI/AN persons, although a portion of the population was excluded.

MeSH terms

  • Alaska / epidemiology
  • Alaska / ethnology
  • Female
  • Humans
  • Incidence
  • Indians, North American / classification*
  • Indians, North American / ethnology
  • Inuits / classification*
  • Inuits / ethnology
  • Longitudinal Studies
  • Male
  • Neoplasms / epidemiology*
  • Neoplasms / ethnology
  • Population Surveillance
  • Registries
  • SEER Program
  • United States / epidemiology
  • United States Indian Health Service*