BACKGROUND: Nationally, American Indian and Alaska Natives (AIAN) are at greater risk of sexually transmitted infections (STI), but California AIAN are often reported as having a lower STI burden. AIAN also have higher rates of race misclassification, particularly in California. The purpose of this study was to assess California AIAN race misclassification in STI surveillance data by linking California Department of Public Health (CDPH) STI surveillance cases with Indian Health Service (IHS) National Patient Information Reporting System (NPIRS) data.
METHODS: Patient identifiers were used to match 2007-2012 CDPH chlamydia, gonorrhea, and primary and secondary (P&S) syphilis surveillance data with NPIRS data of AIAN who accessed a California Indian health clinic between 1984 and 2013.
RESULTS: California surveillance data originally identified 3,374 AIAN STI cases. This linkage resulted in the identification of an additional 4,561 AIAN STI cases. Of these cases, 1,165 were of Hispanic ethnicity and not included in these analyses because cases of Hispanic ethnicity could be of any race and were therefore not misclassified. The overall race misclassification rate was 50.2%. Specifically, misclassification rates were 50.9% for chlamydia, 47.3% for gonorrhea, and 34.7% for P&S syphilis. Overall, AIAN were most frequently misclassified as Unknown or White. Misclassification did not significantly vary by age or gender; however, AIAN residing in urban counties were misclassified at significantly higher rates than AIAN in rural counties (χ2 = 192.83, p-value < .001).
CONCLUSIONS: Findings indicate that race misclassification contributes to the underestimation of AIAN STI burden in California, and that health educators, practitioners, and policymakers should use caution when interpreting existing AIAN California STI surveillance data. Implications for research, practice, and policy will be discussed.