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David Dodds, PhD, MPH Epidemiology and Evaluation Section

Effects of Racial and Ethnic Aggregation on Birth Outcome Measures for the American Indian Population of California (2000-2002). David Dodds, PhD, MPH Epidemiology and Evaluation Section Maternal, Child and Adolescent Health Branch California Department of Health Services December, 2006

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David Dodds, PhD, MPH Epidemiology and Evaluation Section

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  1. Effects of Racial and Ethnic Aggregation on Birth Outcome Measures for the American Indian Population of California (2000-2002) David Dodds, PhD, MPH Epidemiology and Evaluation Section Maternal, Child and Adolescent Health Branch California Department of Health Services December, 2006 ddodds@dhs.ca.gov

  2. Background: American Indian Population and California • California has the largest American Indian population among states: • 333,000 (race alone, Census 2000) • 628,000 (race alone or in combination, Census 2000)1 • California is home to: • 12 percent of the United States population • 13.5 percent of the American Indian/Alaska Native population2 • Los Angeles County has the largest American Indian population among United States counties.3 • California is home to 106 of 561 federally recognized tribes.4 • Most American Indians in California declare ancestry deriving from non-California tribes.5 *Sources: (1) Census 2000 Summary File 1, Table QT-P6; (2) State of California, Department of Finance, Census 2000: Summary File 1 California Profile, Sacramento, California, 2002.; (3) Census 2000 PHC-T-14,Table 11; (4) Federal Register, November 25, 2005, Vol. 70, No. 226: 71194-71198 ; (5) Census 2000 PHC-T-18, Table 19.

  3. Background: Births and Disparities • California ranks third in number of American Indian births among states: • Rank 1: Oklahoma (≈ 5,000 per year) • Rank 2: New Mexico (≈ 3,500 per year) • Rank 3: California (≈ 3,000 per year)1 • Disparities persist for American Indians in California and the United States as measured by birth outcomes: • Infant mortality • Low birth weight • Pre-term delivery Source: (1) Martin, JA, et al. (2003). Births: Final Data for 2002. National Vital Statistics Reports, Vol. 52, No. 10. Hyattsville, Maryland: National Center for Health Statistics (Table 11).

  4. Infant Mortality Rate, California and United States, 2000-2002 Linked Files, by Race* *Race regardless of Hispanic ethnicity. Sources, California and United States: Matthews, TJ, et al. (2004). Infant mortality statistics from the 2002 period linked birth/infant death data set. National Vital Statistics Reports, Vol. 53, No. 10. Hyattsville, Maryland: National Center for Health Statistics (Table 3). Healthy People 2010, wonder.cdc.gov/data2010.

  5. Study Problem • Race and ethnicity are conventional categories for assessing health disparities in public health. • Current federal guidelines (OMB 1997) require separate categories of race and ethnicity for data collection.1 • The federal race category “American Indian or Alaska Native” overlaps significantly with: • Other races (alone or in combination) • Hispanic ethnicity Source: (1) Office of Management and Budget, 1997, Revisions to the Standards for the Classification of Federal Data on Race and Ethnicity, Federal Register Notice, October 30, 1997, www.whitehouse.gov/omb/fedreg/1997standards.html.

  6. Study Questions • Given overlap between races and ethnicity for American Indians, do different racial/ethnic aggregation techniques alter birth outcome measures? • Are some racial/ethnic aggregation techniques more useful than others?

  7. California: Race and Ethnicity • California has a large Hispanic population. • Race/ethnicity data are often aggregated before analysis: Hispanics first into one group with remainder groups as non-Hispanic race groups. • This technique can diminish statistical size of the American Indian population in states like California.

  8. Example of “Hispanic First” Aggregation:California Resident Live Births by Maternal Race and Ethnicity, 2005(N=548,700) All race groups are Non-Hispanic for White, Asian, African American, Multiple Race, Pacific Islander, American Indian. Data source: Birth Statistical Master File, 2005, analysis by author.

  9. Example Data:California Resident Births 2000-2002 Pooled, by Race and Ethnicity (Number) Source: Linked birth and death cohort files, California, 2000-2002, analysis by author.

  10. Example Data:California Resident Births 2000-2002 Pooled, by Race and Ethnicity (Percent) Source: Linked birth and death cohort files, California, 2000-2002, analysis by author.

  11. Study Problem (continued) • Among federally defined race groups in California, overlap with Hispanic ethnicity was highest for American Indians in Census 2000: • 46% of Californians who chose American Indian race alone indicated Hispanic ethnicity.1 • 39% of Californians who chose American Indian as race alone or in combination with another race, indicated Hispanic ethnicity.2 Source: American Fact Finder, factfinder.census.gov: (1) Census 2000 Summary File 1 (SF 1), P8. Hispanic or Latino by Race [17] - Universe: Total population; (2) Census 2000 Summary File 1 (SF 1), P10. Hispanic or Latino by Race (Total Races Tallied) [15] - Universe: Total races tallied.

  12. Study Problem (continued) • For California births, there are somewhat similar overlaps in race and ethnicity. • California linked files for births and deaths during 2000-2002 show that: • 21% of births by American Indian race alone overlap with Hispanic ethnicity.1 • 34% of births by American Indian race alone or combination overlap with Hispanic ethnicity.1 Source: Linked birth and death cohort files, California, 2000-2002, analysis by author.

  13. Methods • Test three aggregation techniques for American Indians: • Technique 1: American Indian race alone, Not Hispanic • Technique 2: American Indian race alone • Technique 3: American Indian race alone or in combination • Assess effects of aggregation technique on three birth outcome measures: • Infant mortality • Percent of births with low birth weight • Percent of pre-term births • Data: Cohort files of linked California birth and death certificates for pooled years 2000-2002. Three years of data: • Improves rate stability assessed by relative standard error (RSE) • Allows for comparison of state and national data as published by the National Center for Health Statistics

  14. Birth Outcome Measures with 95% Confidence Intervals:Three Aggregation Techniques for American Indians/Alaska Natives Resident to California, 2000-2002 Birth cohort denominators, 2000-2002 pooled: 1) Infant Mortality N=5,927; LBW N=5,926, PTD N=5,365. 2) Infant Mortality N=7,468; LBW N=7,467; PTD N=6,769. 3) Infant Mortality N=17,172; LBW N=17,172; PTD N=15,825. Data filters: LBW, birthweight 227 to 8650 grams; PTD, gestational age 17 to 47 weeks.

  15. Birth Outcome Measures byAggregation Technique for American Indians/Alaska Natives Resident to California, 2000-2002 Source: Linked birth and death cohort files, California, 2000-2002, analysis by author.

  16. Results • Alternative aggregation techniques can change descriptive birth outcome measures. • As aggregations use less restrictive criteria: • denominators increase in size • confidence intervals narrow in width • outcome measures (rates, percents) vary • However, the three techniques tested do not produce measures significantly different from each other. Confidence intervals (95%) overlap across techniques for each birth outcome measure.

  17. Conclusions • Technique 1: “American Indian Race Alone, Not Hispanic” • Advantages: Captures important demographic trends in California related to growth of the Hispanic population by immigration and high fertility. Exclusive categories are easy to understand: all numbers sum to 100%. • Disadvantage: Possibly too restrictive for assessing health needs of the California American Indian population since “race alone” population may be moved to Hispanic • Technique 2: “American Indian Race Alone” • Advantages: Captures the racial heterogeneity of people with American Indian ancestry. Avoids “loss to Hispanics.” Exclusive categories are easy to understand: all numbers sum to 100%. • Disadvantage: Loss of Hispanic category misses large scale demographic trend. • Technique 3: “American Indian Race Alone or in Combination” • Advantage: Captures the most racial heterogeneity (i.e., racial overlap) of people with American Indian ancestry. • Disadvantage: Inclusive categories may be confusing because they sum to more than 100% of the population.

  18. Public Health Implications • Different racial/ethnic aggregation techniques can provide alternative perspectives for assessing health disparities for heterogeneous populations like American Indians of California. • However, in the case of birth outcome measures for California the techniques tested did not provide significantly different measures. Other measures and other states may be different. • Each technique has its own advantages and disadvantages.

  19. Public Health Implications • Choice of a useful racial/ethnic aggregation technique must address purposes of data use. • Choice of aggregation technique involves trade-offs among criteria such as: • Ability to identify a population for a target purpose (e.g., health services access or detecting a particular disparity) • Ability to compare birth outcomes measures in published literature • Ease of interpretation by the public

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