摘要：Racial misclassification is a well-documented weakness of mortality data taken from death certificates. As a result, mortality statistics for American Indians and Alaska Natives (AI/ANs) present, at best, an inaccurate and misleading assessment of mortality in this population. Studies evaluating the quality of race/ethnicity reporting on death certificates have linked data from death certificates to other data sources collected when the decedent was still alive (e.g., Census, Current Population Survey). Such studies have shown substantial misclassification of AI/AN decedents. Despite limitations, linking mortality data from death certificates with data from other sources collected when decedents were living provides opportunities to evaluate and correct misclassification of populations such as AI/AN persons and facilitates the calculation and presentation of more accurate mortality statistics. Mortality data provide critical information for measuring health in the United States. Knowing why and how people die helps researchers understand the nature and magnitude of health problems and is important for the planning, implementation, and evaluation of public health strategies and programs. 1–3 Mortality data are widely used and relied on to provide health information at the national, state, and local levels. 4 Of the 10 great public health achievements of the 20th century enumerated by the Centers for Disease Control and Prevention, most have been measured wholly or in part using mortality data. 5 Open in a separate window A proud Inuit village elder, Stephen Weyiouanna (with his grandson in the background) has lived in Shishmaref—a village located on Sarichef Island in the Chukchi Sea, just north of the Bering Strait—all his life. Recently, the community voted to relocate to the Alaska mainland, as their island is slowly being washed into the sea. In the past, the island was protected from winter storms by sea ice, which is melting earlier in the season, given rising temperatures attributable to climate change. Printed with permission of Corbis . Addressing racial and ethnic disparities in health and mortality is an important priority in US public health efforts. 6 A large body of research has been done to understand why some racial/ethnic groups have better health and mortality outcomes than others. 7 The reduction of racial/ethnic disparities in health was an important focus of Healthy People 2000, 8 and this goal was strengthened with the introduction of Healthy People 2010 to entail the elimination of racial/ethnic disparities in health. 9 Eliminating disparities remains an important goal of Healthy People 2020. 10 Nevertheless, racial/ethnic differences in health and mortality persist and remain pervasive. Accurate assessment of racial/ethnic disparities and tracking progress on these goals depends on the quality, validity, and reliability and proper measurement of the data that are reported. However, well-documented problems with reporting of race and ethnicity in mortality data complicate researchers’ ability to accurately measure and thereby assess disparities for some racial/ethnic groups. 11–14 Misclassification has been particularly pronounced for American Indians/Alaska Natives (AI/ANs). The result is that death data for AI/AN populations at the national level and within most states presents, at best, an inaccurate and misleading assessment of mortality in this group. Mortality data in the US National Vital Statistics System allow for the production of mortality statistics for small populations and small areas because of the uniformity of death certificate content across the country and the virtual completeness of the data. This has important implications for the production of mortality statistics for population subgroups such as AI/AN communities that are too small to be adequately represented in survey data based on sampling. The fact that the racial and ethnic information in the National Vital Statistics System is not sufficiently accurate greatly weakens an otherwise powerful resource for the assessment of AI/AN health.
