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Reporting of Race and Ethnicity in the National Notifiable Diseases Surveillance System, 1990

Since 1989, all state health departments have reported cases of infectious diseases to the National Notifiable Diseases Surveillance System (NNDSS) * through the National Electronic Telecommunications System for Surveillance (NETSS) (1). Electronic reporting allows reporting of additional information, including demographic data, that can be used to help define the scope of public health problems for different groups and to develop appropriate preventive interventions. This report describes reporting through NNDSS of notifiable diseases by patients' race/ethnicity for 1990.

Final data for 36 notifiable diseases are reported to the NNDSS through NETSS (Table 1); data on other notifiable conditions are obtained from other surveillance systems. Collection of race/ethnicity data began in 10 states in 1985; the first year all states collected these data for an entire year was 1990. During 1990, racial/ethnic categories for reporting to the NNDSS were American Indian or Alaskan Native, Asian or Pacific Islander, black, Hispanic, and white (Table 2) (2). **

Overall, during 1990, 53% of notifiable disease cases reported to the NNDSS were reported as individual case records (Table 1); the remaining cases of notifiable diseases were reported by states as numbers only, without demographic information. Exclusion of the number of varicella cases (nearly half the total cases reported), increases the reporting of individual case records to 95%.

Of the 195,682 cases reported as individual case records to the NNDSS during 1990, 135,115 (69%) included information on race/ethnicity (Table 1); reporting of race/ethnicity varied by disease and state (Tables 1 and 3). For six diseases of low frequency (i.e., less than 70 cases reported nationally in 1990), 90% of the individual case reports included information on race/ethnicity. Three diseases -- measles, salmo-nellosis, and shigellosis -- accounted for 65% of reports that did not include race/ethnicity. For example, of 48,603 cases of salmonellosis reported to the NNDSS as individual case records, 25,626 (53%) contained information on race/ethnicity. Race/ethnicity information was not included for 37% of measles and 29% of shigellosis case records. Lower levels of reporting of race/ethnicity information for salmonellosis and shigellosis may reflect reliance on lab reporting for these conditions. Race/ethnicity was indicated for 90% or more of individual case reports for measles, salmonellosis, and shigellosis by 23, 11, and five states, respectively. Reported by: State and territorial epidemiologists. Div of Surveillance and Epidemiology, Epidemiology Program Office, CDC.

Editorial Note

Editorial Note: The incidence of many infectious diseases varies among racial/ethnic groups (3,4); factors that may be associated with these variations may include access to preventive services, socioeconomic status, and culture. These differences in disease incidence have important implications for disease prevention and control activities. For example, in 1990 incidence rates for measles were highest for Hispanics and blacks and probably reflected lower levels of vaccination coverage among Hispanic and black children (5). Therefore, interventions were targeted to affected communities through radio public service announcements and the involvement of neighborhood institutions, including schools and churches.

Variations in completeness of reporting of race/ethnicity by disease may reflect differences in reporting sources and frequency of case investigation by state and local health departments. Information on race/ethnicity may be less likely to be reported to state health departments for diseases that are reported by laboratories and do not require further investigation by local or state health departments; this may account for the low level of reporting of race/ethnicity for salmonellosis. However, investigations of suspected measles cases are required to confirm that a reported case meets the surveillance case definition (6). The data missing for measles likely reflects the burden of undertaking such case investigations, as well as the reporting of individual case records during large outbreaks (5).

One of the national health objectives for the year 2000 is to develop and implement a national process to identify important data needs for disease prevention and health promotion, including data for racial/ethnic minorities, and to establish mechanisms to meet these needs (objective 22.4). Unlike socioeconomic status or cultural factors, data on race/ethnicity are collected in routine notifiable disease reports; until more direct information on socioeconomic status or cultural factors is available, public health officials must rely on indirect measures. Improved reporting and analyses of these data should facilitate more effective targeting of disease prevention efforts.


  1. CDC. National Electronic Telecommunications System for Surveillance -- United States, 1990-1991. MMWR 1991;40:502-3.

  2. Office of Management and Budget. Directive no. 15: race and ethnic standards for federal statistics and administrative reporting. In: Statistical policy handbook. Washington, DC: Office of Federal Statistical Policy and Standards, US Department of Commerce, 1987:37-8.

  3. Buehler JW, Stroup DF, Klaucke DN, et al. The reporting of race and ethnicity in the National Notifiable Diseases Surveillance System. Public Health Rep 1989;104:457-85.

  4. Sumaya CV. Major infectious diseases causing excess morbidity in the Hispanic population. Arch Intern Med 1991;151:1513-20.

  5. CDC. Measles -- United States, 1990. MMWR 1991;40:369-72.

  6. CDC. Case definitions for public health surveillance. MMWR 1990;39(no. RR-13).

    • In the United States, reporting of communicable diseases by physicians and other health-care providers is mandated by state law or regulation. Under the leadership of the Council of State and Territorial Epidemiologists, reports of 49 diseases and conditions are forwarded to CDC for weekly publication in MMWR and annual publication in the Summary of Notifiable Diseases. ** In 1991, the categories and definitions used in reporting race/ethnicity to the NNDSS changed so that information on ethnicity (Hispanic origin or non-Hispanic origin) is collected separately from race.

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