Misracialization of Indigenous people in population health and mortality studies: a scoping review to establish promising practices

Abstract

Indigenous people are often misracialized as other racial or ethnic identities in population health research. This misclassification leads to underestimation of Indigenous-specific mortality and health metrics, and subsequently, inadequate resource allocation. In recognition of this problem, investigators around the world have devised analytic methods to address racial misclassification of Indigenous people. We carried out a scoping review based on searches in PubMed, Web of Science, and the Native Health Database for empirical studies published after 2000 that include Indigenous-specific estimates of health or mortality and that take analytic steps to rectify racial misclassification of Indigenous people. We then considered the weaknesses and strengths of implemented analytic approaches, with a focus on methods used in the US context. To do this, we extracted information from 97 articles and compared the analytic approaches used. The most common approach to address Indigenous misclassification is to use data linkage; other methods include geographic restriction to areas where misclassification is less common, exclusion of some subgroups, imputation, aggregation, and electronic health record abstraction. We identified 4 primary limitations of these approaches: (1) combining data sources that use inconsistent processes and/or sources of race and ethnicity information; (2) conflating race, ethnicity, and nationality; (3) applying insufficient algorithms to bridge, impute, or link race and ethnicity information; and (4) assuming the hyperlocality of Indigenous people. Although there is no perfect solution to the issue of Indigenous misclassification in population-based studies, a review of this literature provided information on promising practices to consider.

Keywords: American Indian/Alaska Native; Indigenous; Native American; classification; health; misclassification; morbidity; mortality.

Figure 1

Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) flow chart of databases searched and studies included or excluded, including databases searched, exclusion criteria applied, and article counts. The flowchart is based on the PRISMA extension for scoping reviews.

Figure 2

Areas of intersection for American Indian and Alaska Native identity in the United States. Areas of intersection, overlap, and nonoverlap in various conceptualizations of Indigenous identity in the United States context. Of note, circles and areas of overlap are not necessarily proportionally accurate.