title: Evaluating Cardiovascular Health Disparities Using Estimated Race/Ethnicity: A Validation Study.
abstract: BACKGROUND
  Methods of estimating race/ethnicity using administrative data are increasingly used to examine and target disparities; however, there has been no validation of these methods using clinically relevant outcomes.
  
  
  OBJECTIVE
  To evaluate the validity of the indirect method of race/ethnicity identification based on place of residence and surname for assessing clinically relevant outcomes.
  
  
  METHODS
  A total of 2387 participants in the Post-MI Free Rx Event and Economic Evaluation (MI FREEE) trial who had both self-reported and Bayesian Improved Surname Geocoding method (BISG)-estimated race/ethnicity information available.
  
  
  METHODS
  We used tests of interaction to compare differences in the effect of providing full drug coverage for post-MI medications on adherence and rates of major vascular events or revascularization for white and nonwhite patients based upon self-reported and indirect racial/ethnic assignment.
  
  
  RESULTS
  The impact of full coverage on clinical events differed substantially when based upon self-identified race (HR=0.97 for whites, HR=0.65 for nonwhites; interaction P-value=0.05); however, it did not differ among race/ethnicity groups classified using indirect methods (HR=0.87 for white and nonwhites; interaction P-value=0.83). The impact on adherence was the same for self-reported and BISG-estimated race/ethnicity for 2 of the 3 medication classes studied.
  
  
  CONCLUSIONS
  Quantitatively and qualitatively different results were obtained when indirectly estimated race/ethnicity was used, suggesting that these techniques may not accurately describe aspects of race/ethnicity related to actual health behaviors.
authors.affiliation: *Department of Medicine, Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women's Hospital, Harvard Medical School, Boston, MA †Aetna, Hartford, CT ‡Aetna, Blue Bell, PA §CVS/Caremark, Woonsocket, RI.
authors.forename: Katsiaryna
authors.initials: K
authors.lastname: Bykov
authors.forename: Jessica M
authors.initials: JM
authors.lastname: Franklin
authors.forename: Michele
authors.initials: M
authors.lastname: Toscano
authors.forename: Wayne
authors.initials: W
authors.lastname: Rawlins
authors.forename: Claire M
authors.initials: CM
authors.lastname: Spettell
authors.forename: Cheryl N
authors.initials: CN
authors.lastname: McMahill-Walraven
authors.forename: William H
authors.initials: WH
authors.lastname: Shrank
authors.forename: Niteesh K
authors.initials: NK
authors.lastname: Choudhry
mesh_terms: D000328:Adult; D001741:Black or African American; D001499:Bayes Theorem; D002317:Cardiovascular Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D003625:Data Collection / Q000379:methods*; D005006:Ethnicity; D005260:Female; D062305:Geographic Mapping; D054625:Healthcare Disparities / Q000208:ethnology*; D006630:Hispanic or Latino; D006801:Humans; D008297:Male; D055118:Medication Adherence / Q000208:ethnology; D008875:Middle Aged; D009203:Myocardial Infarction / Q000188:drug therapy* / Q000628:therapy; D009275:Names; D044469:Racial Groups; D012111:Residence Characteristics; D057566:Self Report; D012959:Socioeconomic Factors; D016896:Treatment Outcome; D044465:White People
chemical_list: D002317:Cardiovascular Agents