Summary
Summary: National health surveillance instruments are intended to monitor important health issues and health status of all populations in the United States. Several population subgroups have disparities in health conditions and health care. To effectively create programs and policies to address these issues requires accurate identification of key population subgroups. Among the subgroups with the highest rates of poor health outcomes is the American Indian/Alaska Native (AIAN) population, which is also at significant risk of misidentification in national surveillance instruments. Selection of data sets for study inclusion was based on significant use of data sets in the literature, collection of AIAN designation, and availability of key health indicators. Thus, the Behavior Risk Factor Surveillance System (BRFSS), the National Health Interview Survey (NHIS), the National Survey of Children’s Health (NSCH), the National Health and Nutrition Examination Survey (NHANES), the National Survey of Drug Use and Health (NSDUH), Population Assessment of Tobacco and Health (PATH), and the Medicare Current Beneficiary Survey (MCBS) were selected. Additionally, the research team reviewed the California Health Interview Survey (CHIS), due to its inclusion of a large AIAN population.
Findings: The authors' initial analyses using the original weights constructed by survey administrators demonstrated that there are significant differences across AIAN groups and among the AIAN population as a whole. Moreover, the size of the AIAN population, as well as the distribution of AIAN groups within that population differed substantially across surveys. Many of the surveys do not explicitly account for AIANs in the weighting process. Moreover, most include the Latino/a population as a single homogeneous group during weighting. To demonstrate that these weighting decisions affect understanding of the AIAN population authors introduced revised weighting targets nine (dimensions) that explicitly account for these factors. The results of the re-weighting should be seen as a “proof of concept” demonstration that accounting for the AIAN population directly in the weighting process can improve understanding of health-related disparities faced by this population.
This study uses data from 2011-2014 California Health Interview Surveys.