Guidelines For Using Racial And Ethnic Groupings In Data .
Guidelines for Using Racial and Ethnic Groupings in DataAnalysesRevision Date: April 30, 2010Primary Contact: Juliet VanEenwyk, Ph.D., State Epidemiologist for Non-Infectious ConditionsPurposeBackgroundWhat Are Race and Ethnicity?Use of Terms in This GuidelineWhy Include Analyses by Racial and Ethnic Groupings in Public Health Assessment?What Racial and Ethnic Groupings Are Used Nationally?GuidelinesGeneral ConsiderationsData CollectionData Tabulation and PresentationGeneral ConsiderationsRecommended Racial and Ethnic GroupingsAlternative Racial and Ethnic GroupingsTime TrendsAppendix 1: Racial and Ethnic Groupings in Washington State Behavioral Risk FactorSurveillance SystemAppendix 2: Methods for Assigning Washington Residents Reporting More Than OneRace to a Single Racial CategoryAppendix 3: Numbers of Events or Respondents among Washington Residents byRace and Ethnicity in Selected Washington State Department of Health DatasetsAppendix 4: Comparison of Rates Using Single Race Only and Bridged FilesAcronymsACS: American Community SurveyAIAN: American Indian or Alaska NativeAPI: Asian or Pacific IslanderBRFSS: Behavioral Risk Factor Surveillance SystemCDC: Centers for Disease Control and PreventionNCHS: National Center for Health StatisticsNHOPI: Native Hawaiian or Other Pacific IslanderOMB: Office of Management and BudgetWSCR: Washington State Cancer RegistryPurposeThe Assessment Operations Group in the Washington State Department of Health coordinatesthe development of guidelines related to data collection, analysis and dissemination in order topromote good professional practice among staff involved in assessment activities within theWashington State Department of Health and in Local Health Jurisdictions in Washington. WhileWashington State Department of Health, Revised April 20101
the guidelines are intended for audiences of differing levels of training, they assume a basicknowledge of epidemiology and biostatistics. They are not intended to recreate basic texts andother sources of information related to the topics covered by the guidelines, but rather they focuson issues commonly encountered in public health practice and where applicable, on issuesunique to Washington State.BackgroundWhat Are Race and Ethnicity?Concepts of race and ethnicity have changed considerably over time. Today, most scientists donot view race as a valid biological construct. Genetic changes tend to show gradual variationacross geographic areas with social and cultural categories of race and ethnic group being onlymodest proxies for continental ancestry. 1,2,3 Researchers, such as Camara Jones, propose that“race is only a rough proxy for socioeconomic status, culture, and genes, but it precisely capturesthe social classification of people in a race-conscious society such as the United States. Thatis, the variable ‘race’ is not a biological construct that reflects innate differences, but a socialconstruct that precisely captures the impacts of racism.” 4(p1212) The meanings attributed toethnicity also vary with some researchers emphasizing cultural heritage, while others emphasizesocial identity. 5 As with racism, to the extent that socio-cultural contexts maintain disadvantageamong members of specific ethnic groups, ethnicity also captures the experience ofdiscrimination.Use of Terms in This GuidelineBecause race and ethnicity are not precisely defined constructs, scientific writers use a variety ofapproaches for referring to these terms. For example, authors sometimes place quotation marksaround race and ethnicity to remind readers of the imprecision and heterogeneity withincategories. Others discuss race and ethnicity as one construct capturing the ambiguity of theseterms, while emphasizing their social and cultural underpinnings. The imprecision of theconstructs themselves can be magnified by data collection irregularities, such as whenclassification is based on appearance rather than self-report.Race and ethnicity in this guideline refer to imprecise social and cultural categories with whichindividuals identify or as reported by next-of-kin in the case of death records. The term “race”indicates one of the five categories specified in the United States Office of Management andBudget (OMB) 1997 Standard 6 and “ethnicity” indicates Hispanic or non-Hispanic origin.“Subpopulation” indicates a grouping within a larger racial category, such as Chinese orJapanese within the Asian category. For the public health technical and professional audiencesfor whom this guideline is intended, we do not use quotation marks around these terms. Wefollow the conventions of the Chicago Manual of Style 15th Edition 7 in capitalizing designationsbased on national and ethnic groups, but not capitalizing those based loosely on color when weuse these terms in the text. The conventions used in this guideline are not intended as arecommendation. The best terminology or ways of presenting these constructs will vary with thedocument’s purpose and intended audience.Why Include Analyses by Racial and Ethnic Groupings in Public HealthAssessment?In the United States and in Washington State, there are large differences in health status by selfidentified racial and ethnic categories. Reducing these disparities is both a national and a stategoal. We need to measure health status and associated risk factors by racial and ethnicgroupings so that we understand the magnitude of the disparities and whether current gaps areincreasing or decreasing. This knowledge can assist with developing interventions to decreasegaps, such as developing policies to reduce inequitable access to educational, economic andcommunity resources that facilitate healthy ways of living; inequitable access to and quality ofmedical care; and inequitable exposure to environmental toxins. Additionally, health careproviders and other service organizations sometimes serve people who primarily identify with oneor a limited number of specific racial or ethnic categories. These providers and organizationsWashington State Department of Health, Revised April 20102
often want to know the health status of the populations they serve. Assessing data by racial andethnic groupings is one way to obtain this perspective.What Racial and Ethnic Groupings Are Used Nationally?In the early 1990s, OMB reviewed Statistical Policy Directive No. 15, the federal guidelines forreporting race and ethnicity that had been in effect since 1977. Based on that review, OMBissued a revised standard in 1997. The standard included an explicit statement that the racial andethnic categories serve social, cultural and political purposes and should not be interpreted asindicating primarily biological or genetic differences among people. The three major changes inthe OMB 1997 Standard are People can identify more than one racial category. Pacific Islanders should not be classified with Asians. The question on Hispanic/Latino ethnicity should be asked before the race question.The minimum categories established in the OMB 1997 Standard are Raceo American Indian or Alaska Native (AIAN): A person having origins in any of theoriginal peoples of North and South America (including Central America), and whomaintains tribal affiliation or community attachment.o Asian: A person having origins in any of the original peoples of the Far East,Southeast Asia, or the Indian subcontinent, including, for example, Cambodia, China,India, Japan, Korea, Malaysia, Pakistan, the Philippine Islands, Thailand andVietnam.o Black or African American: A person having origins in any of the black racialgroups of Africa. Terms such as "Haitian" or "Negro" can be used in addition to"Black or African American."o Native Hawaiian or Other Pacific Islander (NHOPI): A person having origins in anyof the original peoples of Hawaii, Guam, Samoa, or other Pacific Islands.o White: A person having origins in any of the original peoples of Europe, the MiddleEast, or North Africa. Ethnic Groupo Hispanic or Latino: A person of Cuban, Mexican, Puerto Rican, South or CentralAmerican or other Spanish culture or origin, regardless of race. The term "Spanishorigin" can be used in addition to "Hispanic or Latino."GuidelinesGeneral ConsiderationsThese recommendations are based on articles by Kaplan MS and Bennett T 8 and Kahn J. 9 Consider the potential health or scientific benefit to providing data by racial and ethnicgroupings; articulate the goal of such an analysis in reports and presentations. Specify how race and ethnicity were collected, including what categories were used;provide a rationale for the categories. Note the imprecision of the racial and ethnic categories, what race and ethnicity areintended to reflect in the specific analysis or document, and conventions for using specificterms. Include an explicit statement of the socio-cultural basis of racial and ethnicgroupings in public health data. Assess potential bias by racial and ethnic groupings due to non-representative sampling,missing data, or other anomalies; use the bias analysis to determine how to best presentand interpret data. Appendix 1 provides an example of such an analysis – as well asdataset-specific guidelines – for the Washington State Behavioral Risk Factor SurveillanceSystem (BRFSS).Washington State Department of Health, Revised April 20103
In discussing differences among racial and ethnic groupingso Do not use racial and ethnic categories as proxies for genetic variation.o Avoid discussing differences as due to inherent underlying traits without clearevidence of such. Distinguish between racial and ethnic groupings as risk factors thatcause disease and risk markers that are associated with disease but not causal. Inmost public health assessment, racial and ethnic groupings are risk markers. Forexample, one hypothesis for the persistently higher rates of preterm delivery amongblack compared to white women in the United States is that black women are exposedto stressors that affect birth outcomes. In this scenario, race is a marker for thesestressors, but not, in itself, a risk factor for preterm delivery. 10o Consider all conceptually relevant factors, such as socioeconomic factors and racism,specifically acknowledging contexts that maintain socioeconomic disadvantage orresult in biological differences. Use caution when statistically controlling for socioeconomic factors in analyses by racial orethnic groupings. To the extent that socioeconomic disadvantage is caused by racial orethnic classification, socioeconomic factors mediate the relationship between theseclassifications and health outcomes. Statistical adjustment for intermediaries can result inbiased estimates of the main effects. 11 As with socioeconomic factors, biologicaldifferences across racial categories can arise in response to environmental factors, such asexposure to harmful physical environments or experiences of racism. 12 To the extent thatbiological factors mediate relationships between racial or ethnic classification and health,statistically controlling for these factors is also likely to result in inaccurate estimates of therelationships between racial or ethnic category and health. Stratified analyses depicting theassociations of racial and ethnic groupings, socioeconomic factors, and health mightprovide a more accurate picture of these relationships than analyses that “control” for oneof these factors to understand the effect of the other. The Robert Wood Johnson brief,“Race and Socioeconomic Factors” 13 illustrates this approach. The small numbers ofobservations in some strata, however, make this approach difficult in Washington.Data CollectionUnless otherwise indicated, the following recommendations are consistent with the OMB 1997Standard and the Provisional Guidance on the Implementation of the 1997 Standards for FederalData on Race and Ethnicity.6,14 Collect data separately for race and Hispanic ethnicity, with Hispanic ethnicity collectedfirst. For Hispanic ethnicity, allow the respondent to select only one option. To help provide more complete race data for Hispanic respondents, consider including,especially for self-administered questionnaires, an instruction to answer both the Hispanicethnicity question and the race question. Allow respondents to select more than one racial grouping.o Allow selection of multiple response options within a single question rather thanincluding a "multiracial" response option. The Provisional Guidance recommends thatthe question wording include "Mark one or more.," "Select one or more.," or"Choose one or more."o Consider the feasibility and usefulness of collecting information on a single racialgrouping for respondents initially reporting more than one race. This approach mightbe useful for comparing current data to data collected under the old federal standardthat allowed reporting of one racial category only. This information can also be usedto assign respondents to a single category when data on multiple racial groupingscannot be used due to bias, small numbers, lack of denominators for developingrates, or other constraints. The OMB 1997 Standard does not recommend thisapproach. The Provisional Guidance suggests using this approach experimentally toprovide survey-specific information for assessing changes over time. Appendix 2provides information on barriers to using multiple race data in Washington, as well asWashington State Department of Health, Revised April 20104
limitations to collecting data on a single racial grouping for those initially reportingmore than one race. Carefully consider the terminology for specifying racial and ethnic categories and the orderin which categories are presented. Unless there are compelling reasons for doingotherwiseo Use the terminology in the OMB 1997 Standard.o Order the categories alphabetically.The Provisional Guidance explicitly states, “There is not ‘one right way’ to ask an individualto report his/her race and ethnicity. Rather, question wording and format should depend onthe mode of administration as well as the context in which the questions are being asked. Also OMB does not recommend a particular order of categories. There are advantagesand disadvantages to various approaches, such as an alphabetical ordering versus theordering of the most prevalent group followed by groups less prevalent.”14(p19) Minimally, include the five racial categories specified by the OMB 1997 Standard andprovide definitions for these categories when possible.o Include an “other” category with an open-ended request to specify. The OMB 1997Standard does not recommend this category, but authorizes its use on the U.S.Census. Including an “other” category and asking people to specify their race canfacilitate assigning records to one of the five standard categories and understandingthe perspective of respondents who do not identify with any of those groupings. Collect subpopulation detail when there are sufficient numbers of events or participants toprovide useable data. Subpopulation categories should beo Able to be aggregated into the minimum categories established in the OMB 1997Standard.o Mutually exclusive. (Not explicitly stated by OMB.)o Consistent with available denominator data if one intends to calculate rates. (Notaddressed by OMB.)o Meaningful to the populations about whom data are being collected. If possible,involve affected communities in developing categories. (Not addressed by OMB.)o Collected through check boxes, flashcards, or categories provided by an interviewer,allowing for an “other” option. Approaches included in the OMB Provisional Guidanceinclude Selecting from a list that includes subpopulations, but not the larger groups towhich the subpopulations belong. With this method, the data analyst assignsindividuals to the larger categories if needed for the analysis. Follow-up questions for those who report a racial category for which additionaldetail is collected. The Provisional Guidance provides an example of thisapproach for Asians and Pacific Islanders. In the example, the subpopulationresponse options for Asians and those for Pacific Islanders are mutuallyexclusive. For example, Filipino is offered as an option for those reportingAsian, but not for those reporting Pacific Islander. The Provisional Guidancedoes not provide recommendations for classifying respondents who answer“other Asian” and then specify a subpopulation assigned to the Pacific Islandergroup and vice versa. For example, they do not recommend how to classify arespondent who first reports “Pacific Islander,” then reports “other PacificIslander” and then specifies “Filipino.” (See Appendix 1, Asian and PacificIslander Subpopulations, second bullet for Washington State Department ofHealth recommendations.) Consider the mode of administration when designing questions and instructions. TheProvisional Guidelines suggest several approaches includingo Showing respondents a flashcard with the categories for face-to-face surveys andhaving definitions available to the interviewer.o Using a check box format for self-administered forms and including definitions forthe minimum racial categories if space allows.Washington State Department of Health, Revised April 20105
oIncluding the minimum number of response categories for telephone surveys andusing follow-up questions to provide more detail. The manner in which the interviewerreads response options is important. To avoid confusion, the interviewer needs topause between categories, e.g., white (pause) black or African American (pause) sothat the respondents do not think they have to choose between black and AfricanAmerican. Standard definitions should be available to the interviewer. Use self-identification rather than observer identification. If self-identification is not possible(e.g., for a deceased person), obtain proxy responses from family or friends. Do not useobserver identification.o OMB emphasizes that self-identification is the preferred method for collecting data onracial and ethnic categories, but allows observer identification if self or proxyreporting is not feasible. The Washington State Department of Health recommendsrecording race and ethnicity as missing if self or proxy reporting is not possible. Thisrecommendation is based on large differences between how respondents classifythemselves and how they report others usually classify them. In the 2004 WashingtonState BRFSS, only about half of respondents reporting AIAN also reported thatothers usually classified them as AIAN; among Hispanics, the comparable figure wasabout 70%. Use translated data collection forms to ensure inclusion of people from diversebackgrounds whenever possible. OMB does not address issues of language or provideadvice on translation. Working with affected communities for translations that reflect local orregional dialects helps assure culturally appropriate translation. When collectingWashington State data by racial and ethnic groupings, forms in multiple languages canreduce bias that might result from variation in English-language proficiency acrossgroupings. Appendix 1 discusses general potential bias by racial and ethnic groupings dueto language barriers with additional detail for Hispanic Ethnicity and Asian and PacificIslander Subpopulations .Data Tabulation and PresentationGeneral ConsiderationsAssess the feasibility, reliability and validity of tabulating and presenting data by the racial andethnic groupings available in the dataset. Do not present data that are not valid and reliable.Appendix 3 provides detail on the numbers of respondents or events by racial and ethniccategories for selected Washington State Department of Health datasets. Although thenumbers seem to be sufficient to support analysis for Hispanics and the OMB minimum racialgroupings, as well as for selected multiple racial groupings and subpopulation detail, the abilityto use these data may be limited due to Lack of denominators needed to calculate rate
ethnic classification, socioeconomic factors mediate the relationship between these classifications and health outcomes. Statistical adjustment for intermediaries can result in biased estimates of the main effects. 11. As with socioeconomic factors, biological
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