Validity of Race and Ethnicity Codes in Medicare Administrative Data Compared With Gold-standard Self-reported Race Collected During Routine Home Health Care Visits

• Published in: Medical care Vol. 58; no. 1; p. e1
• Main Authors: Jarrín, Olga F, Nyandege, Abner N, Grafova, Irina B, Dong, XinQi, Lin, Haiqun
• Format: Journal Article
• Language: English
• Published: United States 01.01.2020
• Subjects: Aged; Aged, 80 and over; Ethnicity - statistics & numerical data; Female; Health Status Disparities; Healthcare Disparities; Home Care Services - statistics & numerical data; Humans; Male; Medicare - statistics & numerical data; Outcome Assessment, Health Care; Predictive Value of Tests; Racial Groups - statistics & numerical data; Reproducibility of Results; Self Report - statistics & numerical data; Sensitivity and Specificity; United States; United States
• ISSN: 1537-1948
• DOI: 10.1097/MLR.0000000000001216

Misclassification of Medicare beneficiaries' race/ethnicity in administrative data sources is frequently overlooked and a limitation in health disparities research. To compare the validity of 2 race/ethnicity variables found in Medicare administrative data [enrollment database (EDB) and Research Triangle Institute (RTI) race] against a gold-standard source also available in the Medicare data warehouse: the self-reported race/ethnicity variable on the home health Outcome and Assessment Information Set (OASIS). Medicare beneficiaries over the age of 18 who received home health care in 2015 (N=4,243,090). Percent agreement, sensitivity, specificity, positive predictive value, and Cohen κ coefficient. The EDB and RTI race variable have high validity for black race and low validity for American Indian/Alaskan Native race. Although the RTI race variable has better validity than the EDB race variable for other races, κ values suggest room for future improvements in classification of whites (0.90), Hispanics (0.87), Asian/Pacific Islanders (0.77), and American Indian/Alaskan Natives (0.44). The status quo of using "good-enough for government" race/ethnicity variables contained in Medicare administrative data for minority health disparities research can be improved through the use of self-reported race/ethnicity data, available in the Medicare data warehouse. Health services and policy researchers should critically examine the source of race/ethnicity variables used in minority health and health disparities research. Future work to improve the accuracy of Medicare beneficiaries' race/ethnicity data should incorporate and augment the self-reported race/ethnicity data contained in assessment and survey data, available within the Medicare data warehouse.