Race/ethnicity information is vital for measuring disparities across groups, and self-report is the gold standard. Many surveys assign simplified race/ethnicity based on responses to separate questions about Hispanic ethnicity and race and instruct respondents to “check all that apply.” When multiple races are endorsed, standard classification methods either create a single heterogenous multiracial group, or attempt to impute the single choice that would have been selected had only one choice been allowed.
To compare 3 options for classifying race/ethnicity: (a) hierarchical, classifying Hispanics as such regardless of racial identification, and grouping together all non-Hispanic multiracial individuals; (b) a newly proposed additive model, retaining all original endorsements plus a multiracial indicator; (c) an all-combinations approach, separately categorizing every observed combination of endorsements.
Cross-sectional comparison of racial/ethnic distributions of patient experience scores; using weighted linear regression, we model patient experience by race/ethnicity using 3 classification systems.
In total, 259,763 Medicare beneficiaries age 65+ who responded to the 2017 Medicare Consumer Assessments of Healthcare Providers and Systems Survey and reported race/ethnicity.
Self-reported race/ethnicity, 4 patient experience measures.
Additive and hierarchical models produce similar classifications for non-Hispanic single-race respondents, but differ for Hispanic and multiracial respondents. Relative to the gold standard of the all-combinations model, the additive model better captures ratings of health care experiences and response tendencies that differ by race/ethnicity than does the hierarchical model. Differences between models are smaller with more specific measures.
Additive models of race/ethnicity may afford more useful measures of disparities in health care and other domains. Our results have particular relevance for populations with a higher prevalence of multiracial identification.
*RAND Corporation, Santa Monica, CA
†Carnegie Mellon University, Heinz College
‡RAND Corporation, Pittsburgh, PA
§Morrison & Associates Inc., Nantucket, MA
∥Division of Consumer Assessment & Plan Performance, Centers for Medicare & Medicaid Services, Baltimore, MD
¶University of Alabama at Birmingham, Birmingham, AL
Supported by a Centers for Medicare & Medicaid Services contract (No. GS-10F-0275P/ Task Order HHSM-500-2017-00083G).
S.G. is an employee of the sponsoring agency. The remaining authors declare no conflict of interest.
Reprints: Marc N. Elliott, PhD, RAND Corporation, 1776 Main Street, Santa Monica, CA 90401. E-mail: firstname.lastname@example.org.