摘要：Objectives. We examined agreement of administrative data with self-reported race/ethnicity and identified correlates of agreement. Methods. We used Veterans Affairs administrative data and VA 1999 Large Health survey race/ethnicity data. Results. Relatively low rates of agreement (approximately 60%) between data sources were largely the result of administrative data from patients whose race/ethnicity was unknown, with least agreement for Native American, Asian, and Pacific Islander patients. After exclusion of patients with missing race/ethnicity, agreement improved except for Native Americans. Agreement did not increase substantially after inclusion of data from individuals indicating multiple race/ethnicities. Patients for whom there was better agreement between data sources tended to be less educated, non–solitary living, younger, and White; to have sufficient food; and to use more inpatient Department of Veterans Affairs (VA) care. Conclusions. Better reporting of race/ethnicity data will improve agreement between data sources. Previous studies using VA administrative data may have underestimated racial disparities. The growing interest in racial disparities in the provision of health care has fostered an increase in the use of race/ethnicity data derived from administrative data files. Despite the increasing demand for and use of these data, their reliability has been examined in only a few studies. This omission is a significant one, because the reliability of racial designations is crucial for accurate estimation of racial disparities in health care. A few previous studies have examined the reliability of racial classifications in administrative data from specific states, the federal government, and national insurance programs. Blustein documented that racial classifications for patients with multiple admissions in hospital discharge data in New York state lacked reliability, especially for non–African American and non-White racial categories. 1 When California birth certificate race/ethnicity data were compared with race/ethnicity information obtained by interview, Baumeister et al. found that the sensitivity of the birth certificate data was significantly lower for Native Americans. 2 In a review of vital statistics on race and ethnicity, Hahn and colleagues noted inconsistencies between birth and death records of infants, especially for Hispanic persons and for races/ethnicities other than White and African American. 3 Pan and colleagues compared racial designations in Medicare and Medicaid data, finding significant amounts of contradictory information on race/ethnicity between the programs, with the greatest discrepancies for Hispanic, “other,” and Asian classifications. 4 Boehmer and colleagues documented that study outcomes differed markedly depending on whether the source of race/ethnicity information was Department of Veterans Affairs (VA) administrative data or self-report data. Specifically, additional race/ethnicity differences in the use of tooth extraction versus root canal therapy were found when self-report data were used. 5 They also noted discrepancies in race/ethnicity classifications between the data sources. Because a number of recent studies on racial variations in cardiac care have been based on VA databases, 6– 10 understanding the accuracy of these data is especially important. One study examined the concordance between medical record data on race/ethnicity in the VA and race/ethnicity as recorded in inpatient administrative data files, finding good agreement. 11 However, this finding is not surprising, given that medical record data serve as the source for inpatient data on race/ethnicity. The agreement of the administrative files with patient self-report was unknown, as were the sociodemographic and health factors associated with such agreement. The purpose of this study was to extend previous research by examining the agreement of VA administrative data on race/ethnicity with patient self-reported race/ethnicity, using information obtained from the largest federal survey ever conducted in the Veterans Health Administration. 12 Thus, in addition to examining general rates of agreement, we assessed the effect of including or excluding patients with missing race/ethnicity information or with multiple race/ethnicity designations in the survey data. A secondary goal of our study was to identify any sociodemographic and health characteristics of patients associated with agreement between data sources.
