Racial misclassification on death certificates leads to inaccurate mortality data for American Indian and Alaska Native (AI/AN) populations. We describe methods for correcting for racial misclassification among non-Hispanic AI/AN (NH-AI/AN) populations using data from the year 2020. We linked National Death Index records with the Indian Health Service (IHS) patient registration database to identify AI/AN decedents. Matches were then linked to the National Vital Statistics System mortality data to identify AI/AN individuals who had been misclassified as another race on their death certificates. Analyses were limited to NH-AI/AN and purchased/referred care delivery areas or urban areas. We compared death rates and counts pre- and postlinkage and calculated sensitivity and classification ratios by region, sex, age, cause of death, and urban area. Racial misclassification on death certificates among NH-AI/AN varied by geographic region. Some of the highest racial misclassification occurred in the Southern Plains and Pacific Coast. Death rates for NH-AI/AN people and differences between NH-AI/AN and non-Hispanic White people were larger using the linked data. Improving AI/AN mortality data using linkages between vital statistics data and IHS strengthens data quality and can help address health disparities through public health planning efforts.
Keywords: American Indian and Alaska Native; data linkages; disparities; mortality; racial misclassification.
Published by Oxford University Press on behalf of the Johns Hopkins Bloomberg School of Public Health 2025. This work is written by (a) US Government employee(s) and is in the public domain in the US.