Eliminating Health Disparities Measurement and Data Needs (2004) / Chapter Skim
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4 DHHS Collection of Data on Race, Ethnicity, Socioeconomic Position, and Acculturation and Language Use
4 DHHS Collection of Data on Race, Ethnicity, Socioeconomic Position, and Acculturation and Language Use
Pages 62-82
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From page 62... ...
, and acculturation and language data collected as part of these systems. We identify gaps in the collection of data for measuring health and health care disparities, and conclude that more could be done to effectively capture, measure, and utilize a broader range of federal health data to understand disparities.
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From page 63... ...
HOUSEHOLD AND INDIVIDUAL SURVEY DATA COLLECTIONS DHHS conducts a number of household surveys that collect information on health and health status, health care utilization, and health care treatment of individuals. The major household surveys and some of their basic characteristics are listed in Appendix A (pages 129-144)
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From page 64... ...
Socioeconomic Position Data Collection National household surveys provide some of the most extensive data on socioeconomic position of all the DHHS health-related data systems, with the NHIS, NHANES, and MEPS collecting the most data on SEP.6 All three of these surveys collect information on employment status, occupation, sources of income and amounts of income from each source, and education levels. Only the MEPS collects information on wealth, requesting 5CAHPS is a survey tool kit developed by DHHS to survey consumers and purchasers of health plans.
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From page 65... ...
The other national household surveys collect limited SEP data -- usually only education level or sometimes employment status. The BRFSS core questionnaire asks four questions on socioeconomic position -- highest level of education achieved, employment status, health insurance coverage status, and a categorical variable for household income.
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From page 66... ...
The other household surveys do not collect extensive data on wealth. There are thus two major limitations of these surveys with regard to SEP data collection: they collect little information on wealth and on measures of income over an individual's life course.
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From page 67... ...
Although all of the DHHS data sets are required to report race and ethnicity in a standardized way using the new OMB standards, trend analysis over the periods prior to and since implementation of the new standards could create a problem for racial classification. For example, under the old standards individuals of mixed racial backgrounds were asked to choose a single racial background, whereas now under the new standards they can choose multiple racial backgrounds.
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From page 68... ...
Only the National Survey of Substance Abuse Treatment Services collects information on the languages offered for treatment services at the facility. MEDICARE DATA Medicare program data have been widely used to study health and health care treatment outcomes, including in studies to measure and understand racial and ethnic disparities in health and health care (Escalante et al., 2002; Escarce et al., 1993; Gornick et al., 1996; Schneider, Zaslavsky, and Epstein, 2002; Skinner et al., 2003)
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From page 69... ...
The Medicare EDB contains information on all Medicare beneficiaries. Although it is based entirely on administrative records and does not contain much detailed information on beneficiaries, it is an important database because it can be linked to other Medicare files that include information on health status, service expenditures and financing, age, and gender.
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From page 70... ...
9In 1991, EDB had only three race categories -- black, white, and other. In 1996 and 1997, EDB included those categories plus Hispanic, Asian/Pacific Islander, and American Indian/ Alaska Native.
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From page 71... ...
The MCBS does collect data on education level and total household income. One possible linkage that would provide a measure of SEP -- specifically, current and lifetime earnings income -- would be to merge SSA earnings data with the EDB, although SSA earnings records are not perfect measures of lifetime income or of the more general concept of SEP (see Dynan, Skinner, and Zeldes, 2004, for a discussion of the use of SSA earnings as a measure of lifetime earnings)
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From page 72... ...
For individuals who meet this maximum, earnings data report only the maximum, not the actual amount of earnings. Despite such weaknesses in the SSA earnings data, they are a potentially very useful source of SEP data for supplementing Medicare enrollee data.
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From page 73... ...
Some disease surveillance systems do not collect any racial and ethnic data -- for example, the Sexually Transmitted Disease Surveillance System. Socioeconomic Position and Acculturation and Language Data SEP data are even more rarely collected in these systems.
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From page 74... ...
is responsible for providing health care services to American Indians and Alaska Natives. This DHHS agency provides health services -- either at IHS facilities or by contract with privatesector providers, tribally operated programs, and urban Indian health programs -- to individuals who are members of or can prove descendence from a member of a federally recognized tribe.
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From page 75... ...
Through its Inclusion Policy and its 1999 report Improving the Collection and Use of Racial and Ethnic Data in Health and Human Services, which included recommendations to improve its racial and ethnic data collection, the department has begun to address some of the data weaknesses highlighted in this chapter. In this section, the panel gives its recommendations for improvements to national data collection efforts.
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From page 76... ...
The panel notes that the DHHS Assistant Secretary for Planning and Evaluation (ASPE) has sponsored work to assess federal health data sets for their ability to provide data on detailed Asian and Hispanic subgroups and on American Indian and Alaska Natives (Waksberg, Levine, and Marker, 2000)
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From page 77... ...
The DHHS Inclusion Policy clearly states the goal of collecting racial and ethnic data for all department programs and record collections and surveys. The department's household surveys all collect racial and ethnic data in accordance with OMB standards.
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From page 78... ...
Data on language proficiency and acculturation could be used both to explain differences in health outcomes across and within ethnicities and to improve health care services and programs so that they better accommodate these populations. Very little information on language use and acculturation is collected in national health surveys and even less is collected in DHHS administrative and surveillance system records.
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From page 79... ...
For example, matching SSA earnings records to Medicare claims data provides a means to understand links between race, ethnicity, and SEP and health care treatment and treatment outcomes. Therefore, where possible, the department should encourage and promote data linkages, including between data sets collected and maintained both in different DHHS agencies and with non-DHHS departments or institutes.
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From page 80... ...
The collection of additional data for current enrollees will not be an easy or inexpensive task. A previous CMS attempt to collect racial and ethnic data through a postcard survey of current enrollees achieved some success in filling in vital missing information (Arday et al., 2000)
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From page 81... ...
Leadership for Implementing OMB Standards for Health Data Collection There is still a lack of understanding and delay in implementation of the new OMB standards for collecting racial and ethnic data, particularly outside the federal statistical community. Many attendees of the panel's Workshop on Improving Race and Ethnicity Data Collection expressed confusion over what the minimum race categories were, whether more detailed categories could be used, how data on Hispanic ethnicity should be collected, how multiple-race responses should be handled, and how data collected before the new standards can be bridged to data collected since the standards were implemented (National Research Council, 2003)
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From page 82... ...
The specific SEP measures used may depend on the outcome of interest (for example, education level may be the most appropriate measure for examining preventive health knowledge and outcomes -- such as the percent of women receiving a mammogram each year) or upon the availability of data.
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