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Discrepancies in Race and Ethnicity in the Electronic Health Record Compared to Self-report

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Journal of Racial and Ethnic Health Disparities Aims and scope Submit manuscript

Abstract 

Objective

Racial and ethnic disparities are commonplace in health care. Research often relies on sociodemographic information recorded in the electronic health record (EHR). Little evidence is available about the accuracy of EHR-recorded sociodemographic information, and none in pediatrics. Our objective was to determine the accuracy of EHR-recorded race and ethnicity compared to self-report.

Methods

Patients/guardians enrolled in two prospective observational studies (10/2014–1/2019) provided self-reported sociodemographic information. Corresponding EHR information was abstracted. EHR information was compared to self-report, considered “gold standard.” Agreement was evaluated with Cohen’s kappa.

Results

A total of 503 patients (42% female, median age 12.8 years) were identified. Self-reported race (N = 484) was 73% White, 16% Black or African American (AA), 4% Asian, 5% multiracial, and 2% other. Self-reported ethnicity (N = 410) was 9% Hispanic/Latino, and 88% non-Hispanic/Latino. Agreement between self-reported and EHR-recorded race was substantial (kappa = 0.77, 95% CI 0.72–0.83). Race was discordant among 10% (47/476). Hispanic/Latino ethnicity also had strong agreement (kappa = 0.77, 95% CI 0.65–0.89). Among those who self-reported Hispanic/Latino and reported race (N = 21), race was less accurately recorded in the EHR (kappa = 0.26, 95% CI 0–0.54). Race did not match among 43% with recorded race (9/21). Among self-reported racial and/or ethnic minorities, 13% (12/164) were misclassified in the EHR as non-Hispanic White.

Conclusions

We found race and ethnicity are often inaccurately recorded in the EHR for patients who self-identify as minorities, leading to under-representation of minorities in the EHR. Inaccurately recorded race and ethnicity has important implications for disparity research, and for informing health policy. Reliable processes are needed to incorporate self-reported race and ethnicity in the EHR at institutional and national levels.

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Funding

This work was supported in part by the Pediatric Research Organization for Kids with Intestinal Disorders (PRO-KIIDS).

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Authors and Affiliations

  1. Division of Pediatric Gastroenterology, 1500 E. Medical Center Dr. C.S. Mott Children’s Hospital, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA

    Joann M. Samalik & Jeremy Adler

  2. Division of Pediatric Cardiology, 1500 E. Medical Center Dr. C.S. Mott Children’s Hospital, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA

    Caren S. Goldberg

  3. Susan B. Meister Child Health Evaluation and Research Center, 2900 Plymouth Rd, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA

    Zubin J. Modi, Emily M. Fredericks, Samir K. Gadepalli, Sally J. Eder & Jeremy Adler

  4. Division of Pediatric Nephrology, 1500 E. Medical Center Dr. C.S. Mott Children’s Hospital, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA

    Zubin J. Modi

  5. Division of Pediatric Psychology, 1500 E. Medical Center Dr. C.S. Mott Children’s Hospital, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA

    Emily M. Fredericks

  6. Division of Pediatric Surgery, 1500 E. Medical Center Dr. C.S. Mott Children’s Hospital, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA

    Samir K. Gadepalli

Authors
  1. Joann M. Samalik
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  7. Jeremy Adler
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection, and analysis were performed by Joann Samalik and Jeremy Adler. The first draft of the manuscript was written by Joann Samalik. All authors approved the final manuscript.

Corresponding author

Correspondence to Jeremy Adler.

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Ethics Approval

The study was approved by the Institutional Review Board of the University of Michigan.

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Written consent and assent was obtained from the patients and/or parents/guardians for participation and publication. No images were included in this manuscript.

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The authors declare no competing interests.

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Samalik, J.M., Goldberg, C.S., Modi, Z.J. et al. Discrepancies in Race and Ethnicity in the Electronic Health Record Compared to Self-report. J. Racial and Ethnic Health Disparities 10, 2670–2675 (2023). https://doi.org/10.1007/s40615-022-01445-w

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  • DOI: https://doi.org/10.1007/s40615-022-01445-w

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