N.C. Maternal and Infant Health Data Dashboard: Appendix

Since 2011, when North Carolina adopted the revised U.S. standards for reporting, birth certificates have included the following self-reported racial categories which allow for multi-race selection based on federal standards issued by the Office of Management and Budget (OMB). The race of the newborn is not collected on birth certificates and cannot be derived from combining maternal and paternal race fields due to a high level of missing paternal race information. For this reason, both federal and state birth data are typically reported based on maternal race alone. More detailed disaggregated race categories are available but are not presented here to protect the confidentiality of these births.

Since 2011, when North Carolina adopted the revised U.S. standards for reporting, birth certificates have included the following self-reported ethnicity categories which allow for multi-ethnicity selection based on federal standards issued by the Office of Management and Budget (OMB). The ethnicity of the newborn is not collected on birth certificates and cannot be derived from combining maternal and paternal ethnicity fields due to a high level of missing paternal race information. For this reason, both federal and state birth data are typically reported based on maternal ethnicity alone. More detailed disaggregated ethnicity categories are available but are not presented here to protect the confidentiality of these births. 

Discharge data are based on hospital billing records and race is not a required field on standard uniform billing forms (UB-04). North Carolina legislation stipulates that race should be self-reported by the patient. The discharge file currently includes the following race categories (Note: These are mutually exclusive categories and there is currently no category for multi-racial):

• American Indian
• Asian
• Black or African American
• Native Hawaiian or Pacific Islander
• Caucasian
• Other Race
• Invalid/Missing

Discharge data are based on billing data and ethnicity is not a required field on standard uniform billing forms (UB-04). North Carolina legislation stipulates that ethnicity should be self-reported by the patient. The file includes the following categories for ethnicity: 

• Hispanic
• Non-Hispanic
• Invalid/Missing

Census Bureau special tabulation population estimates provide disaggregated North Carolina population figures by county of residence, single year age groupings, race (including a multiracial category), and ethnicity. For non-census years, estimates are derived from the American Community Survey (ACS). The ACS is a survey conducted annually by the Census Bureau that provides information that used to be included on the long form of the US Census. The ACS fills in gaps in information between census periods. Information on race and ethnicity are self-reported by ACS respondents. 

The Census Bureau estimates include the following racial groupings, which are consistent with 1997 Office of Management and Budget (OMB) standards for collection of race information:

• White alone
• Black alone
• American Indian or Alaskan Native alone
• Asian alone
• Native Hawaiian and other Pacific Islander alone
• Two or more races

For ethnicity, Census Bureau population estimates include the following two ethnicity categories, which are consistent with 1997 Office of Management and Budget (OMB) standards for collection of ethnicity information: 

• Hispanic
• Non-Hispanic

Data users should be aware that the Hispanic/Latino population may not identify with the race categories provided in public health surveillance systems, such as the birth certificate. Hispanic/Latino individuals may identify their race as something non-classifiable in the Other (Specify) category. As a result, tabulations of data based on race alone may result in a high proportion of other and unknown races that are not suitable for comparative analysis. Best practice would be to combine the race and ethnicity fields together to address this issue.  

Sources:

• Urban Institute, 2019: Separating Race from Ethnicity in Surveys Risks an Inaccurate Picture of the Latinx Community 
• Pew Research Center, 2021: Measuring the racial identity of Latinos