Quality of ethnicity data within Scottish health records and implications of misclassification for ethnic inequalities in severe COVID-19: a national linked data study

Sarah Amele; Ronan McCabe; Eliud Kibuchi; Anna Pearce; Kirsten Hainey; Evangelia Demou; Patricia Irizar; Dharmi Kapadia; Harry Taylor; James Nazroo; Laia Bécares; Duncan Buchanan; Paul Henery; Sandra Jayacodi; Lana Woolford; Colin R Simpson; Aziz Sheikh; Karen Jeffrey; Ting Shi; Luke Daines; Holly Tibble; Fatima Almaghrabi; Adeniyi Francis Fagbamigbe; Amanj Kurdi; Chris Robertson; Serena Pattaro; Srinivasa Vittal Katikireddi

doi:10.1093/pubmed/fdad196

Quality of ethnicity data within Scottish health records and implications of misclassification for ethnic inequalities in severe COVID-19: a national linked data study

Sarah Amele, Ronan McCabe, Eliud Kibuchi, Anna Pearce, Kirsten Hainey, Evangelia Demou, Patricia Irizar, Dharmi Kapadia, Harry Taylor, James Nazroo, Laia Bécares, Duncan Buchanan, Paul Henery, Sandra Jayacodi, Lana Woolford, Colin R Simpson, Aziz Sheikh, Karen Jeffrey, Ting Shi, Luke DainesHolly Tibble, Fatima Almaghrabi, Adeniyi Francis Fagbamigbe, Amanj Kurdi, Chris Robertson, Serena Pattaro, Srinivasa Vittal Katikireddi

Research output: Contribution to journal › Article › peer-review

Abstract / Description of output

BACKGROUND: We compared the quality of ethnicity coding within the Public Health Scotland Ethnicity Look-up (PHS-EL) dataset, and other National Health Service datasets, with the 2011 Scottish Census.

METHODS: Measures of quality included the level of missingness and misclassification. We examined the impact of misclassification using Cox proportional hazards to compare the risk of severe coronavirus disease (COVID-19) (hospitalization & death) by ethnic group.

RESULTS: Misclassification within PHS-EL was higher for all minority ethnic groups [12.5 to 69.1%] compared with the White Scottish majority [5.1%] and highest in the White Gypsy/Traveller group [69.1%]. Missingness in PHS-EL was highest among the White Other British group [39%] and lowest among the Pakistani group [17%]. PHS-EL data often underestimated severe COVID-19 risk compared with Census data. e.g. in the White Gypsy/Traveller group the Hazard Ratio (HR) was 1.68 [95% Confidence Intervals (CI): 1.03, 2.74] compared with the White Scottish majority using Census ethnicity data and 0.73 [95% CI: 0.10, 5.15] using PHS-EL data; and HR was 2.03 [95% CI: 1.20, 3.44] in the Census for the Bangladeshi group versus 1.45 [95% CI: 0.75, 2.78] in PHS-EL.

CONCLUSIONS: Poor quality ethnicity coding in health records can bias estimates, thereby threatening monitoring and understanding ethnic inequalities in health.

Original language	English
Article number	fdad196
Journal	Journal of public health (Oxford, England)
Early online date	19 Oct 2023
DOIs	https://doi.org/10.1093/pubmed/fdad196
Publication status	E-pub ahead of print - 19 Oct 2023

Keywords / Materials (for Non-textual outputs)

quality
ethnicity
COVID-19

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10.1093/pubmed/fdad196Licence: Creative Commons: Attribution (CC-BY)

Quality of Ethnicity Data_DOA12092023_VOR_CC-BYFinal published version, 389 KBLicence: Creative Commons: Attribution (CC-BY)

https://academic.oup.com/jpubhealth/advance-article/doi/10.1093/pubmed/fdad196/7323289Licence: Creative Commons: Attribution (CC-BY)

Cite this

Amele, S., McCabe, R., Kibuchi, E., Pearce, A., Hainey, K., Demou, E., Irizar, P., Kapadia, D., Taylor, H., Nazroo, J., Bécares, L., Buchanan, D., Henery, P., Jayacodi, S., Woolford, L., Simpson, C. R., Sheikh, A., Jeffrey, K., Shi, T., ... Katikireddi, S. V. (2023). Quality of ethnicity data within Scottish health records and implications of misclassification for ethnic inequalities in severe COVID-19: a national linked data study. Journal of public health (Oxford, England), Article fdad196. Advance online publication. https://doi.org/10.1093/pubmed/fdad196

@article{124b5171e5fb44c7a224c0c9b9defc9c,

title = "Quality of ethnicity data within Scottish health records and implications of misclassification for ethnic inequalities in severe COVID-19: a national linked data study",

abstract = "BACKGROUND: We compared the quality of ethnicity coding within the Public Health Scotland Ethnicity Look-up (PHS-EL) dataset, and other National Health Service datasets, with the 2011 Scottish Census.METHODS: Measures of quality included the level of missingness and misclassification. We examined the impact of misclassification using Cox proportional hazards to compare the risk of severe coronavirus disease (COVID-19) (hospitalization & death) by ethnic group.RESULTS: Misclassification within PHS-EL was higher for all minority ethnic groups [12.5 to 69.1%] compared with the White Scottish majority [5.1%] and highest in the White Gypsy/Traveller group [69.1%]. Missingness in PHS-EL was highest among the White Other British group [39%] and lowest among the Pakistani group [17%]. PHS-EL data often underestimated severe COVID-19 risk compared with Census data. e.g. in the White Gypsy/Traveller group the Hazard Ratio (HR) was 1.68 [95% Confidence Intervals (CI): 1.03, 2.74] compared with the White Scottish majority using Census ethnicity data and 0.73 [95% CI: 0.10, 5.15] using PHS-EL data; and HR was 2.03 [95% CI: 1.20, 3.44] in the Census for the Bangladeshi group versus 1.45 [95% CI: 0.75, 2.78] in PHS-EL.CONCLUSIONS: Poor quality ethnicity coding in health records can bias estimates, thereby threatening monitoring and understanding ethnic inequalities in health.",

keywords = "quality, ethnicity, COVID-19",

author = "Sarah Amele and Ronan McCabe and Eliud Kibuchi and Anna Pearce and Kirsten Hainey and Evangelia Demou and Patricia Irizar and Dharmi Kapadia and Harry Taylor and James Nazroo and Laia B{\'e}cares and Duncan Buchanan and Paul Henery and Sandra Jayacodi and Lana Woolford and Simpson, {Colin R} and Aziz Sheikh and Karen Jeffrey and Ting Shi and Luke Daines and Holly Tibble and Fatima Almaghrabi and Fagbamigbe, {Adeniyi Francis} and Amanj Kurdi and Chris Robertson and Serena Pattaro and Katikireddi, {Srinivasa Vittal}",

note = "SA, RM, EK, AP, KH, ED & SVK acknowledge funding from the Medical Research Council (MC_UU_00022/2 & MC_ST_00022) and the Scottish Government Chief Scientist Office (SPHSU17). SVK also acknowledges funding from a National Records of Scotland Senior Clinical Fellowship (SCAF/15/02). ",

year = "2023",

month = oct,

day = "19",

doi = "10.1093/pubmed/fdad196",

language = "English",

journal = "Journal of public health (Oxford, England)",

issn = "1741-3842",

publisher = "Oxford University Press",

}

Amele, S, McCabe, R, Kibuchi, E, Pearce, A, Hainey, K, Demou, E, Irizar, P, Kapadia, D, Taylor, H, Nazroo, J, Bécares, L, Buchanan, D, Henery, P, Jayacodi, S, Woolford, L, Simpson, CR , Sheikh, A, Jeffrey, K, Shi, T , Daines, L , Tibble, H, Almaghrabi, F, Fagbamigbe, AF, Kurdi, A, Robertson, C, Pattaro, S & Katikireddi, SV 2023, 'Quality of ethnicity data within Scottish health records and implications of misclassification for ethnic inequalities in severe COVID-19: a national linked data study', Journal of public health (Oxford, England). https://doi.org/10.1093/pubmed/fdad196

TY - JOUR

T1 - Quality of ethnicity data within Scottish health records and implications of misclassification for ethnic inequalities in severe COVID-19

T2 - a national linked data study

AU - Amele, Sarah

AU - McCabe, Ronan

AU - Kibuchi, Eliud

AU - Pearce, Anna

AU - Hainey, Kirsten

AU - Demou, Evangelia

AU - Irizar, Patricia

AU - Kapadia, Dharmi

AU - Taylor, Harry

AU - Nazroo, James

AU - Bécares, Laia

AU - Buchanan, Duncan

AU - Henery, Paul

AU - Jayacodi, Sandra

AU - Woolford, Lana

AU - Simpson, Colin R

AU - Sheikh, Aziz

AU - Jeffrey, Karen

AU - Shi, Ting

AU - Daines, Luke

AU - Tibble, Holly

AU - Almaghrabi, Fatima

AU - Fagbamigbe, Adeniyi Francis

AU - Kurdi, Amanj

AU - Robertson, Chris

AU - Pattaro, Serena

AU - Katikireddi, Srinivasa Vittal

N1 - SA, RM, EK, AP, KH, ED & SVK acknowledge funding from the Medical Research Council (MC_UU_00022/2 & MC_ST_00022) and the Scottish Government Chief Scientist Office (SPHSU17). SVK also acknowledges funding from a National Records of Scotland Senior Clinical Fellowship (SCAF/15/02).

PY - 2023/10/19

Y1 - 2023/10/19

N2 - BACKGROUND: We compared the quality of ethnicity coding within the Public Health Scotland Ethnicity Look-up (PHS-EL) dataset, and other National Health Service datasets, with the 2011 Scottish Census.METHODS: Measures of quality included the level of missingness and misclassification. We examined the impact of misclassification using Cox proportional hazards to compare the risk of severe coronavirus disease (COVID-19) (hospitalization & death) by ethnic group.RESULTS: Misclassification within PHS-EL was higher for all minority ethnic groups [12.5 to 69.1%] compared with the White Scottish majority [5.1%] and highest in the White Gypsy/Traveller group [69.1%]. Missingness in PHS-EL was highest among the White Other British group [39%] and lowest among the Pakistani group [17%]. PHS-EL data often underestimated severe COVID-19 risk compared with Census data. e.g. in the White Gypsy/Traveller group the Hazard Ratio (HR) was 1.68 [95% Confidence Intervals (CI): 1.03, 2.74] compared with the White Scottish majority using Census ethnicity data and 0.73 [95% CI: 0.10, 5.15] using PHS-EL data; and HR was 2.03 [95% CI: 1.20, 3.44] in the Census for the Bangladeshi group versus 1.45 [95% CI: 0.75, 2.78] in PHS-EL.CONCLUSIONS: Poor quality ethnicity coding in health records can bias estimates, thereby threatening monitoring and understanding ethnic inequalities in health.

AB - BACKGROUND: We compared the quality of ethnicity coding within the Public Health Scotland Ethnicity Look-up (PHS-EL) dataset, and other National Health Service datasets, with the 2011 Scottish Census.METHODS: Measures of quality included the level of missingness and misclassification. We examined the impact of misclassification using Cox proportional hazards to compare the risk of severe coronavirus disease (COVID-19) (hospitalization & death) by ethnic group.RESULTS: Misclassification within PHS-EL was higher for all minority ethnic groups [12.5 to 69.1%] compared with the White Scottish majority [5.1%] and highest in the White Gypsy/Traveller group [69.1%]. Missingness in PHS-EL was highest among the White Other British group [39%] and lowest among the Pakistani group [17%]. PHS-EL data often underestimated severe COVID-19 risk compared with Census data. e.g. in the White Gypsy/Traveller group the Hazard Ratio (HR) was 1.68 [95% Confidence Intervals (CI): 1.03, 2.74] compared with the White Scottish majority using Census ethnicity data and 0.73 [95% CI: 0.10, 5.15] using PHS-EL data; and HR was 2.03 [95% CI: 1.20, 3.44] in the Census for the Bangladeshi group versus 1.45 [95% CI: 0.75, 2.78] in PHS-EL.CONCLUSIONS: Poor quality ethnicity coding in health records can bias estimates, thereby threatening monitoring and understanding ethnic inequalities in health.

KW - quality

KW - ethnicity

KW - COVID-19

U2 - 10.1093/pubmed/fdad196

DO - 10.1093/pubmed/fdad196

M3 - Article

C2 - 37861114

SN - 1741-3842

JO - Journal of public health (Oxford, England)

JF - Journal of public health (Oxford, England)

M1 - fdad196

ER -

Quality of ethnicity data within Scottish health records and implications of misclassification for ethnic inequalities in severe COVID-19: a national linked data study

Abstract / Description of output

Keywords / Materials (for Non-textual outputs)

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Cite this