Vitals Ethnicity Data: A New Approach to Disparities Research

1. Vitals Ethnicity Data: A New Approach to Disparities Research • Bruce Cohen, • Malena Hood, and James K. West Massachusetts Department of Public Health Division of Research and Epidemiology

2. Outline • The added value of ethnicity for understanding disparities • Examples from natality data • Examples from mortality data • Analytic issues • Concluding thoughts

3. Basic concepts Race: group or groups that an individual identifies with because they share similar physical characteristics or social and geographic origins. Ethnicity: a person’s background, heritage, culture, ancestry, country of birth

4. OF RACE can be used to monitor discrimination yields more stable rates (has denominators) adheres to OMB standard more routinely collected OF ETHNICITY better understood less context dependent more useful for program targeting and development improved sensitivity to linguistic needs added insight into acculturation Added value of each…

5. WITH RACE changing over time not clearly understood conceptually context dependent heterogeneity within groups used as proxy WITH ETHNICITY lack of denominators for population based rates small numbers for analysis requires more complex data collection geographic variability Concerns…

6. Advantages Client-centered care target interventions monitor demographic change health statusmonitoring Disadvantages expanded IT efforts moves beyond Federal minimum standards lack of denominator data for calculating rates increases data collector and respondent burden Collecting both…

7. Ethnicity in Births

8. Ethnicity Variables in Massachusetts Birth Data • Hispanic ethnicity • Mother’s ancestry • Father’s ancestry • Infant’s ancestry is based on the mother’s race and ethnicity as indicated on the birth certificate

9. Parent’s Worksheet – Race Question • Massachusetts Births – Parent Worksheet • MOTHER'S RACE (Please mark the one category that best describes the mother's race): • 1 □ White2 □ Black3 □ Asian/Pacific Islander4 □ American Indian5 □ Other (specify):_____________________

10. Parent’s Worksheet – Ancestry Question MOTHER'S ANCESTRYPlease mark the one category that best describes the mother's ancestry or ethnic heritage: HISPANIC/LATINA 1 □ Puerto Rican2 □ Dominican3 □ Mexican4 □ Cuban5 □ Colombian6 □ Salvadoran7 □ Other Central American (specify):_____ 8 □ Other South American (specify):_____ 9 □ Other Hispanic/Latina (specify):______ ASIAN/PACIFIC ISLANDER 10 □ Chinese11 □ Vietnamese12 □ Cambodian13 □ Asian Indian14 □ Korean15 □ Filipino16 □ Japanese17 □ Laotian18 □ Pakistani19 □ Thai20 □ Hawaiian21 □ Other Asian/Pacific Islander (specify):____ PORTUGUESE SPEAKING 22 □ Cape Verdean23 □ Brazilian24 □ Other Portuguese (specify):_________ WEST INDIAN/CARIBBEAN ISLANDER 25 □ Haitian26 □ Jamaican27 □ Barbadian28 □ Other West Indian/Caribbean Islander (specify):_____ AFRICAN/AFRICAN AMERICAN 29 □ African-American/ Afro-American 30 □ Nigerian31 □ Other African (specify):__________ MIDDLE EASTERN 32 □ Lebanese33 □ Iranian34 □ Israeli35 □ Other Middle Eastern (specify):_____ AMERICAN ANCESTRY 36 □ Native American/ American Indian (specify tribe/affiliation): ____________________37 □ American EUROPEAN and OTHER ancestries 38 □ European (specify):______________ 39 □ Other (specify):_________________

11. Cesarean Delivery by Race and Ethnicity, Massachusetts: 2008 * Statistically different from state rate (p<0.05)

12. Cesarean Delivery by EthnicityMassachusetts: 2008 * Statistically different from state rate (p<0.05)

13. Gestational Diabetes by Race and Ethnicity, Massachusetts: 2008 * Statistically different from state rate (p<0.05)

14. Gestational Diabetes by EthnicityMassachusetts: 2008 * Statistically different from state rate (p<0.05)

15. Gestational Diabetes Mellitus (GDM) and Asian Indian Births Massachusetts: 2000-2008

16. Low Birthweight by Race and Ethnicity, Massachusetts: 2008 * Statistically different from state rate (p<0.05)

17. Low Birthweight Infants by Ethnicity Massachusetts: 2008 * Statistically different from state rate (p<0.05)

18. Breastfeeding by Race and EthnicityMassachusetts: 2008 * Statistically different from state rate (p<0.05)

19. Breastfeeding by EthnicityMassachusetts: 2008 * Statistically different from state rate (p<0.05)

20. Smoking During Pregnancy by Race and Ethnicity, Massachusetts: 2008 * Statistically different from state rate (p<0.05)

21. Smoking During Pregnancy by Ethnicity, Massachusetts: 2008 * Statistically different from state rate (p<0.05)

22. Ethnicity in Deaths

23. Ethnicity Ascertainment • The gold standard, self identification, is not available • Ethnicity is supplied by the informant or assumed by the funeral director • For research, ethnicity can be ascertained through a combination of variables

24. Variables for Ethnicity • Hispanic ethnicity • Race • Decedent, Father, and Mother’s place of birth

25. Ethnicity - Hispanic ethnicity • Hispanic ethnicity codes • Puerto Rican • Dominican • Cuban • Other Central American • South American • Mexican • Other and Unknown Hispanic

26. Ethnicity - Race Race codes • White • Black • Indian • Chinese • Japanese • Hawaiian • Laotian • Vietnamese • Thai • Cambodian • Filipino • Other Asian or Pacific Islander • Cape Verdean • Other Non-White • Hispanic • N/A

27. Ethnicity – Place of Birth • Text fields • Country of Birth • City of Birth

28. Cape Verdean Deaths (Non-Hispanic)Massachusetts: 2008

29. Chinese Deaths Massachusetts: 2008

30. Brazilian Deaths Massachusetts: 2008

31. Asian Indian Deaths Massachusetts: 2008

32. Irish Deaths Massachusetts: 2008 Note: 9 decedents were born in Northern Ireland and are not included

33. Puerto Rican Deaths Massachusetts: 2008

34. Analytic Issues

35. How to Use Ethnicity Data? • Exploring better denominators from American Community Survey and other data sources • Descriptive: numerator-based and proportion of population measures • Analytic: numerator-based • Standardized odds ratios

36. Standardized Mortality Odds Ratio (SMOR) • Often used to study cause specific mortality when population denominators are not available. • To estimate an SMOR, one first computes the ratio of deaths from cause A (the cause of interest) to the deaths from cause B (the "control" cause of death) in an exposed sample. • This ratio is then compared with an analogous ratio from a standard population.

37. SMOR =a b c d X 100 Standardized Mortality Odds Ratio (SMOR)

38. a (20) b (2,800) * c (331) d (50,190) = 20 * 50,190 331 * 2,800 = SMOR[Chinese] =108.3 Example: Standardized Mortality Odds Ratio (SMOR)

39. Injury Deaths by Race and Ethnicity Massachusetts: 2008 * Statistically different from White non-Hispanic rate (p<0.05)

40. Cancer Deaths by Race and Ethnicity Massachusetts: 2008 * Statistically different from White non-Hispanic rate (p<0.05)

41. Race and Ethnicity by Age Group Massachusetts Deaths: 2008

42. Injury Deaths by Race and Ethnicity Persons <= 65 YearsMassachusetts: 2008 * Statistically different from White non-Hispanic rate (p<0.05)

43. Cancer Deaths by Race and EthnicityPersons <= 65 Years Massachusetts: 2008 * Statistically different from White non-Hispanic rate (p<0.05)

44. Concluding Thoughts

45. New Mother/Parent Ethnicity

46. NewMother/Parent Race

47. Concluding Thoughts • Increased diversity in population requires more thoughtful use of data to monitor disparities and target public health programs-ethnicity can do this. • Vitals data are a superb source to provide the needed information • Key 1: Training data collectors to ascertain quality information • Key 2: Collaboration among Vitals, analysts, and policy makers to develop and use data to address disparities • Use what you collect

48. Questions • Contacts: • Bruce Cohen: Bruce.Cohen@state.ma.us • To access data via MassCHIP (DPH’s Internet based public health information service): Website: http://masschip.state.ma.us Telephone: 1-888-MASCHIP (Mass only (617) 624-5629

50. Additional Slides