Misclassification of Race/Ethnicity On Gonorrhea Case Reports – Minnesota, 2006-2008

Background: Race/ethnicity may be underreported or misreported by medical providers, making it difficult to describe gonorrhea trends by this key demographic category.

Objectives: (1) To evaluate the accuracy of case-reported race/ethnicity by comparing against self-report; (2) To examine correlates of having misclassified race/ethnicity.

Methods: Persons residing in Hennepin County and diagnosed with gonorrhea outside of the county STD clinic from July 2006-August 2008 were contacted via phone by the Minnesota Department of Health to gather supplementary surveillance data including race/ethnicity. Self-reported and case-reported race/ethnicity was compared using Cohen’s kappa. Factors associated with having misclassified race/ethnicity were assessed using chi-square significance testing.

Results: Thirty percent of eligible cases were interviewed (n=737). Race/ethnicity was missing for 14.4% of case reports vs. 0.5% of case interviews. Agreement between self-reported and provider-reported race/ethnicity was only moderate (kappa=0.56). Misclassification was significantly higher among cases reporting American Indian (p<0.01), multiple (p<0.0001) and Hispanic (p<0.0001) race/ethnicity at interview; age, gender, and clinic type were non-significant.

Conclusions: The accuracy of race/ethnicity data gathered through routine STD case reporting is moderate at best when compared with self-reports. Clinics serving high proportions of American Indian, multiracial, and Hispanic patients should be especially vigilant in collecting patient-defined race/ethnicity.

Implications for Programs, Policy, and/or Research:Racial misclassification could result in underestimation of STD morbidity in certain sub-populations and should be assessed periodically by STD surveillance programs.