across the country that may not have a large presence in Massachusetts (e.g., Navajo, which may be of importance in Arizona). Thus, the subcommittee concluded that the Massachusetts Superset provides an ample, but not complete, set of granular ethnicity categories. Similarly, the Kaiser Permanente Granular Ethnicity Code Set was determined to be representative of many, but perhaps not all, granular ethnicities.

To capture all of the granular ethnicities represented in the United States, the subcommittee reviewed the Census Bureau’s Ancestry Code List. The Census Ancestry Code List is compiled from responses to the Census’ open-ended ancestry question, which allows respondents to write in their lineage or ancestry.1 Thus, the list includes a myriad of granular ethnicity categories, ranging from Hausa, an ethnic group in northern Nigeria, to more general responses of European and American.

The CDC/HL7 Code Set, Massachusetts Superset, Census Ancestry Code List, and Kaiser Permanente Granular Ethnicity Code Set interchangeably use country or place names to indicate ethnicities (i.e., Singapore to represent Singaporean). The subcommittee revised the list to represent categories with ethnicities as opposed to places, whenever possible; this is reflected in the subcommittee’s template (Table E-1).

The CDC/HL7 Code Set includes an extensive list of American Indian or Alaska Native categories and codes. Thus, the CDC/HL7 Code Set may serve as the template from which entities can choose locally relevant tribal categories and codes. The Census Ancestry Code list does not include American Indian or Alaska Native tribes. The Massachusetts Superset and the Kaiser Permanente Granular Ethnicity Code Set both include limited lists of locally relevant tribes.

ADAPTION OF THE TEMPLATE TO A NATIONAL STANDARD LIST

The subcommittee presents a cumulative list of granular ethnicity categories from different sources (Table E-1) that may serve as a template from which the Department of Health and Human Services (HHS) should develop a national standard list of granular ethnicity categories with accompanying unique codes (Recommendation 6-1a). Some of these granular ethnicities have already been assigned permanent five-digit unique numerical codes by CDC/HL7. The remaining granular ethnicities included in the subcommittee template also need permanent five-digit unique numerical codes.

To indicate which categories and codes may be similar, the Public Use Microdata Sample File (PUMS) considers some Census ancestry codes to have “corresponding detailed ancestry codes” (i.e., Hausa may be said to correspond with Nigeria).2 The subcommittee concluded that because of the large number of very specific ethnicities included on the Census Ancestry Code List, some ethnicities would be best presented as corresponding with others. Corresponding ethnicities are indicated in Table E-1 using indents. When HHS is developing codes for the granular ethnicity categories included in this template (per Recommendation 6-1a), corresponding ethnicities may have the same codes (i.e., one or more granular ethnicity categories may have the same code).

ROLLUP TO THE OMB RACE AND HISPANIC ETHNICITY CATEGORIES

Locally tailored quality improvement activities may target granular ethnicity groups without needing to relate those groups to a single OMB race category. Collecting race, Hispanic ethnicity, and granular ethnicity data separately, as the subcommittee recommends, allows reporting of the OMB categories when necessary without requiring rollup of the granular ethnicities, provided that individuals respond to all the questions asked. Nonetheless, the subcommittee recognizes that data collected under some circumstances (e.g., a reporting request for OMB-level data where only granular ethnicity is collected) cannot be used or compared with data collected using the OMB race and Hispanic ethnicity categories without the use of a rollup scheme to link granular ethnicities to the OMB categories. To examine both the feasibility and limitations of such schemes, the subcommittee mapped in Table E-1

1

The CDC/HL7 Code Set was developed using write-in responses to the Census questions on race and Hispanic ethnicity, not responses to the Census ancestry question. The Census ancestry list is more comprehensive than the list used to develop the CDC/HL7 Code Set.

2

U.S. Census Bureau. 2007. ACS 1-year PUMS code lists: Ancestry codes. http://www.census.gov/acs/www/Products/PUMS/C2SS/CodeList/2007/Ancestry.htm (accessed June 23, 2009).



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