title: Racial misclassification of American Indians and Alaska Natives by Indian Health Service Contract Health Service Delivery Area.
abstract: OBJECTIVE
  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.
authors.affiliation: Melissa A. Jim is with the Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Albuquerque, NM. Elizabeth Arias is with the Division of Vital Statistics, National Center for Health Statistics, Centers for Disease Control and Prevention, Hyattsville, MD. Dean S. Seneca is with the Division of Public Health Capacity Development, Office for State, Tribal, Local and Territorial Support, Centers for Disease Control and Prevention, Atlanta, GA. Megan J. Hoopes is with the Northwest Tribal Epidemiology Center, Northwest Portland Area Indian Health Board, Portland, OR. Cheyenne C. Jim is with Immunization Services Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Albuquerque, NM. Norman J. Johnson is with the National Longitudinal Mortality Study Branch, US Census Bureau, Suitland, MD. Charles L. Wiggins is with the New Mexico Tumor Registry, University of New Mexico Cancer Center, Albuquerque.
authors.forename: Melissa A
authors.initials: MA
authors.lastname: Jim
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Arias
authors.forename: Dean S
authors.initials: DS
authors.lastname: Seneca
authors.forename: Megan J
authors.initials: MJ
authors.lastname: Hoopes
authors.forename: Cheyenne C
authors.initials: CC
authors.lastname: Jim
authors.forename: Norman J
authors.initials: NJ
authors.lastname: Johnson
authors.forename: Charles L
authors.initials: CL
authors.lastname: Wiggins
mesh_terms: D000413:Alaska / Q000453:epidemiology / Q000208:ethnology; D005260:Female; D006801:Humans; D015994:Incidence; D007198:Indians, North American / Q000145:classification* / Q000208:ethnology; D004930:Inuit / Q000145:classification* / Q000208:ethnology; D008137:Longitudinal Studies; D008297:Male; D009369:Neoplasms / Q000453:epidemiology* / Q000208:ethnology; D011159:Population Surveillance; D012042:Registries; D018426:SEER Program; D014481:United States / Q000453:epidemiology; D016549:United States Indian Health Service
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