Misracialization of Indigenous people in population health and mortality studies: a scoping review to establish promising practices

Abstract

Indigenous people are often misracialized or misclassified as other racial or ethnic identities in population health research. This misclassification leads to underestimation of Indigenous-specific mortality and health metrics, and subsequently, inadequate resource allocation. In recognition of this problem, investigators around the world have devised analytic methods to address racial misclassification of Indigenous people. We carried out a scoping review based on searches in PubMed, Web of Science, and the Native Health Database for empirical studies published after 2000 that include Indigenous-specific estimates of health or mortality and that take analytic steps to rectify racial misclassification of Indigenous people. We then considered the weaknesses and strengths of implemented analytic approaches, with a focus on methods used in the United States (U.S.) context. To do this, we extracted information from 97 articles and compared the analytic approaches used. The most common approach to address Indigenous misclassification is to use data linkage, though other methods include geographic restriction to areas where misclassification is less common, exclusion of some subgroups, imputation, aggregation, and electronic health record abstraction. We identified four primary limitations of these approaches: (1) combining data sources that use inconsistent process and/or sources of race and ethnicity information, (2) conflating race, ethnicity, and nationality, (3) applying insufficient algorithms to bridge, impute, or link race and ethnicity information, and (4) assuming the hyperlocality of Indigenous people. While there is no perfect solution to the issue of Indigenous misclassification in population-based studies, a review of this literature provided promising practices to consider.

Asking MultiCrit Questions: A Reflexive and Critical Framework to Promote Health Data Equity for the Multiracial Population

“…Sometimes, self-identified race data are not readily available-such as with death certificates-raising concerns of racial misclassification. 98 Death certificates are used to produce official mortality and life expectancy estimates, important indicators of population health. Funeral directors are responsible for assigning demographic information to the decedent 99 ; however, a 2002 study found that half of surveyed funeral directors reported receiving no formal training to do so, and half reported assigning race solely based on visual observation instead of asking next of kin, per Centers for Disease Control and Prevention (CDC) guidance.…”