Missing Race and Ethnicity Data among COVID-19 Cases in Massachusetts

Abstract

Infectious disease surveillance frequently lacks complete information on race and ethnicity, making it difficult to identify health inequities. Greater awareness of this issue has occurred due to the COVID-19 pandemic, during which inequities in cases, hospitalizations, and deaths were reported but with evidence of substantial missing demographic details. Although the problem of missing race and ethnicity data in COVID-19 cases has been well documented, neither its spatiotemporal variation nor its particular drivers have been characterized. Using individual-level data on confirmed COVID-19 cases in Massachusetts from March 2020 to February 2021, we show how missing race and ethnicity data: (1) varied over time, appearing to increase sharply during two different periods of rapid case growth; (2) differed substantially between towns, indicating a nonrandom distribution; and (3) was associated significantly with several individual- and town-level characteristics in a mixed-effects regression model, suggesting a combination of personal and infrastructural drivers of missing data that persisted despite state and federal data-collection mandates. We discuss how a variety of factors may contribute to persistent missing data but could potentially be mitigated in future contexts.

Missing data and missed infections: investigating racial and ethnic disparities in SARS-CoV-2 testing and infection rates in Holyoke, Massachusetts

“…Prior research has shown that differences in the ordering and question format for race and ethnicity data can result in inconsistent answers. 40 , 41 Misclassifications at the outset would propagate into the multiple imputation procedure. We attempted to mitigate this through our data-cleaning process, which was informed by discussions with Holyoke testing sites about how race and ethnicity data were collected.…”

The Tenacious Treponema: A Retrospective Examination of Syphilis Treatment Disparities in Washington, DC

“…11,12 An important example of this in public health research was the finding that missing race data in COVID cases reported in Massachusetts did not occur randomly among all races and was most notable among minority races. 13 These findings of inequities in the time to treatment of syphilis along racial lines demands further investigation into contributory factors. We identified overall high treatment adequacy for early syphilis, however, 68 cases of early syphilis lacked treatment documentation or had inadequate treatment and may represent opportunities for intervention.…”

“…In large surveys, it has been demonstrated that underrepresented minorities such as African Americans, Latinx, and Asian/Pacific Islanders are less likely to report their race than White survey respondents 11,12 . An important example of this in public health research was the finding that missing race data in COVID cases reported in Massachusetts did not occur randomly among all races and was most notable among minority races 13 . These findings of inequities in the time to treatment of syphilis along racial lines demands further investigation into contributory factors.…”

Missing data and missed infections: Investigating racial and ethnic disparities in SARS-CoV-2 testing and infection rates in Holyoke, Massachusetts

“…Second, there was no standardized method of collecting race or ethnicity information at testing facilities. Prior research has shown that differences in the ordering and question format for race and ethnicity data can result in inconsistent answers [39,40].…”