Reports on Racial Misclassification

Racial misclassification of AI/AN people endangers lives, but it can be prevented.  For over a year, the National Council of Urban Indian Health (NCUIH) investigated factors that may create racial misclassification and looked for concrete recommendations to prevent these factors.   In 2020, the COVID-19 pandemic thrust death certificate data quality into the national spotlight and NCUIH revisited its analysis.

The Role of Funeral Directors in Policy and Prevention

This report examines the problem of racial misclassification on death certificates, with a particular focus on the role of funeral directors in urban communities.  The document is intended as a broad and introductory guide for a variety of stakeholders that can help prevent this problem, including funeral directors, businesses and industry associations, statisticians and public health experts, and policy stakeholders.

The report consists of 5 parts:

  1. A review of the vital records system and relevant literature.
  2. A description of a survey, listening sessions, and interviews conducted by NCUIH to learn about funeral director policies, practices, and experiences.
  3. Results from these activities.
  4. A discussion of what NCUIH learned.
  5. A list of recommendations to prevent racial misclassification on death certificates.

Determinants of Racial Misclassification in COVID-19 Mortality Data: The Role of Funeral Directors and Social Context

At the beginning of COVID-19 pandemic, rapid provisional death counts were based on death certificates and used to identify outbreaks and allocate resources.  Due to this national spotlight, NCUIH revisited its analysis of the death certification process. This paper reviews two central questions: (1) what determinants of AI/AN racial misclassification emerge funeral directors policies and practices? and (2) what can be inferred about COVID-19 mortality data quality based on these analyses and events during the pandemic?

Based on a review of funeral director factors heading into the pandemic and changes in the death registration context since, NCUIH expected high levels of American Indian and Alaska Native misclassification in mortality data, both for COVID-19 and unrelated deaths. This is especially likely for any deaths early in the pandemic, or during any periods of high transmission and severe strain on funeral directors and hospitals. For more information, see the American Indian Culture and Research Journal.