Health United States 2020-2021

Race

In 1977, the federal Office of Management and Budget (OMB) issued “Race and Ethnic Standards for Federal Statistics and Administrative Reporting” (Statistical Policy Directive 15) to promote comparability of data among federal data systems. The 1977 standards called for the federal government’s data systems to classify people into the following four racial groups: American Indian or Alaskan Native, Asian or Pacific Islander, Black, and White. Depending on the data source, the classification by race was based on self-classification or on observation by an interviewer or other person filling out the questionnaire.

In 1997, revisions were announced for classification of people by race within the federal government’s data systems. Unless otherwise noted, recent data by race and ethnicity in Health, United States have implemented the “Revisions to the Standards for the Classification of Federal Data on Race and Ethnicity” issued in 1997 by OMB, available from: https://www.govinfo.gov/content/pkg/FR-1997-10-30/pdf/97-28653.pdf. The 1997 standards allow for observer or proxy identification of race but clearly state a preference for self-classification. The 1997 standards called for the federal government’s data systems to classify people into the following groups: American Indian or Alaska Native; Asian; Black or African American; Native Hawaiian or Other Pacific Islander; White; and Hispanic or Latino. The Asian or Pacific Islander race group was split into two different race groups under the 1997 standards: Asian and Native Hawaiian or Other Pacific Islander. The 1997 standards also offer respondents an opportunity to select more than one race group, leading to many possible multiple-race categories. Generally, a small percentage of people report two or more races (2.8% in 2019). A race group can be defined in two basic ways when respondents have the option of reporting multiple races. A group such as Black may be defined as those who reported Black and no other race (the “race alone” or single-race concept), or as those who reported Black regardless of whether they also reported another race (the “race alone or in combination” concept). In Health, United States, indicators present data using the first approach (single race). Use of the single-race population does not imply that it is the preferred method of presenting or analyzing data.

Estimates for race groups using the 1997 standards are not completely comparable with data based on the earlier 1977 standards. For more information, see: Heron M. Comparability of race-specific mortality data based on 1977 versus 1997 reporting standards. National Vital Statistics Report; vol 70, no 3. Hyattsville, MD: National Center for Health Statistics. 2021.  Available from: https://www.cdc.gov/nchs/data/nvsr/nvsr70/nvsr70-03-508.pdf.

Starting with data year 1999, most National Center for Health Statistics survey estimates by race are presented based on the 1997 standards. Vital statistics systems, however, transitioned to the 1997 standards over time as states adopted the 2003 revision of the U.S. standard certificates of live birth and death, which contained the 1997 standards. The 2003 revisions were not adopted by all states until 2016 for the birth file, 2017 for the linked birth/infant death file, and 2018 for the mortality file. Before that, most race data for vital statistics used the 1977 standards. During this transition, vital record data needed to be comparable across states and with population data collected under the 1997 OMB standards. This was done by bridging the race information collected under the 1997 standards to be consistent with data collected under the 1977 standards. For more information, see Sources and Definitions, Population census and population estimates, bridged-race population estimates.

Recent vital statistics data in Health, United States are presented for the following six race and Hispanic-origin groups under the 1997 OMB standards: non-Hispanic American Indian or Alaska Native; non-Hispanic Asian; non-Hispanic Black or African American; non-Hispanic Native Hawaiian or Other Pacific Islander; non-Hispanic White; and Hispanic or Latino. Life expectancy and survey estimates by race and Hispanic origin are generally presented for fewer race and Hispanic-origin groups due to sample size and reliability issues. Data on race and Hispanic origin are collected separately. People of Hispanic origin may be of any race.

Birth file

Information about the race and Hispanic origin of the mother and father is provided by the mother at the time of birth and recorded on the birth certificate. Since 1980, birth rates and birth characteristics are presented in Health, United States according to race of the mother. Before 1980, data were tabulated by race of the newborn and fetus, considering the race of both parents. If the parents were of different races and one parent was White, the child was classified according to the race of the other parent. When neither parent was White, the child was classified according to father’s race, with one exception: If either parent was Hawaiian, the child was classified as Hawaiian. As of 1964, unknown race is classified according to information on the birth record. Before 1964, if race was unknown, the birth was classified as White.

Starting with 2003 data, some states began using the 2003 revision of the U.S. Standard Certificate of Live Birth, which incorporated the 1997 OMB standards allowing the reporting of more than one race (multiple races). In 2019, 2.7% of mothers in the 50 states and District of Columbia (D.C.) reported more than one race. Until all states adopted the 2003 revision and the 1997 OMB standards, both numerators and denominators needed to be bridged to the 1977 standards. As of 2016, all states and D.C., in addition to Puerto Rico, U.S. Virgin Islands, Guam, and Northern Mariana Islands, use the 2003 revision of the U.S. Standard Certificate of Live Birth and report race according to the 1997 revised OMB standards. For more information on the adoption of the 2003 revision of the U.S. Standard Certificate of Live Birth, see the Technical Notes section of the annual series of “Births: Final Data” reports, available from: https://www.cdc.gov/nchs/products/nvsr.htm.

Estimates for race groups using the 1997 standards are not completely comparable with data based on the 1977 standards.

Mortality file

Information about the race and Hispanic origin of a decedent is reported by the funeral director as provided by an informant (often the surviving next of kin), or in the absence of an informant, based on observation. Death rates by race and Hispanic origin are based on information from death certificates (numerators of the rates) and on population estimates from the U.S. Census Bureau (denominators). Race and ethnicity information from the census is by self-report. To the extent that race and Hispanic origin are inconsistent between these two data sources, death rates will be biased. Studies have shown that people who self-reported as American Indian or Alaska Native, Asian, or Hispanic on census and survey records may sometimes be reported as White or non-Hispanic on the death certificate, resulting in an underestimation of deaths and death rates for the American Indian or Alaska Native, Asian, and Hispanic groups. Bias also results from undercounts of some population groups in the census—particularly young Black males, young White males, and elderly people—resulting in an overestimation of death rates.

Race and ethnicity reporting on the death certificate continues to be excellent for the White and Black populations. It remains poor for the American Indian or Alaska Native population but is reasonably good for the Hispanic and the combined Asian or Pacific Islander populations. Decedent characteristics such as place of residence and nativity have an important effect on the quality of reporting on the death certificate. The effects of misclassification on mortality estimates have been most pronounced for the American Indian or Alaska Native population, where correcting for misclassification reverses a large American Indian or Alaska Native-over-White mortality advantage to a relatively large disadvantage. Among the Hispanic and Asian or Pacific Islander populations, adjustment for death certificate misclassification has not significantly affected minority-majority mortality. For more information, see: Arias E, Heron M, Hakes JK. The validity of race and Hispanic-origin reporting on death certificates in the United States: An update. National Center for Health Statistics. Vital Health Stat 2(172). 2016. Available from: https://www.cdc.gov/nchs/data/series/sr_02/sr02_172.pdf; and Arias E, Schauman WS, Eschbach K, Sorlie PD, Backlund E. The validity of race and Hispanic origin reporting on death certificates in the United States. National Center for Health Statistics. Vital Health Stat 2(148). 2008. Available from: https://www.cdc.gov/nchs/data/series/sr_02/sr02_148.pdf.

Issues affecting the interpretation of vital event rates for the American Indian or Alaska Native population include (a) changes in the classification or self-identification of people of American Indian or Alaska Native heritage over time, and (b) misclassification of American Indian or Alaska Native people on death certificates by the funeral director or informant. Vital event rates for the American Indian or Alaska Native population shown in Health, United States are based on the total U.S. resident American Indian or Alaska Native population, as enumerated by the U.S. Census Bureau. In contrast, the Indian Health Service calculates vital event rates for this population based on Census Bureau county data for American Indian or Alaska Native people who reside on or near reservations. Because of misclassification of American Indian or Alaska Native people on death certificates, American Indian or Alaska Native national and state-specific mortality estimates published in Health, United States should be interpreted with caution.

Interpretation of trends for the Asian population in the United States should consider that this population more than doubled between 1980 and 1990, primarily because of immigration. From 1990 to 2000, the increase in the Asian population was 48% for people reporting that they were Asian alone and 72% for people who reported they were either Asian alone or Asian in combination with another race.

Starting with 2003 data, some states began using the 2003 revision of the U.S. Standard Certificate of Death, which incorporated the 1997 OMB standards allowing the reporting of more than one race (multiple races). In 2019, fewer than 1.0% of deaths in the 50 states and D.C. recorded more than one race. Until all states adopted the 2003 revision and the 1997 OMB standards, both numerators and denominators needed to be bridged to the 1977 standards. Beginning with 2018 data, all states and D.C. report deaths using the 2003 revision of the death certificate and report race according to the 1997 OMB standards. For more information, see: National Center for Health Statistics. NCHS procedures for multiple-race and Hispanic-origin data: Collection, coding, editing, and transmitting. 2004. Available from: https://www.cdc.gov/nchs/data/dvs/Multiple_race_docu_5-10-04.pdf; and National Center for Health Statistics. Vital statistics of the United States, vol II, Mortality, part A, Mortality Technical Appendices. Published annually, available from: https://www.cdc.gov/nchs/products/vsus/ta.htm.

Estimates for race groups using the 1997 standards are not completely comparable with data based on the 1977 standards.

National Health Interview Survey (NHIS)

Starting with Health, United States, 2002, race-specific estimates based on NHIS were tabulated using the 1997 standards for data year 1999 and beyond and are not strictly comparable with estimates for earlier years. The 1997 standards specify five single- and multiple-race categories. Estimates for specific race groups are shown when they meet requirements for statistical reliability and confidentiality. The race categories American Indian or Alaska Native only, Asian only, Black or African American only, Native Hawaiian or Other Pacific Islander only, and White only include people who reported only one racial group; the category of two or more races includes people who reported more than one of the five racial groups in the 1997 standards or one of the five racial groups and “some other race.” To maintain consistency with U.S. Census Bureau procedures for collecting and editing data on race and ethnicity, NHIS made major changes to its editing procedures in the 2003 data year. For the 2003–2018 NHIS, Other race was not available as a separate race response. This response category was treated as missing, and the race was imputed if this was the only race response. In cases where Other race was mentioned along with one or more race groups, the Other race response was dropped, and the race group information was retained. Beginning with the 2019 NHIS, Other race is again available as a response category.

Before data year 1999, data were tabulated according to the 1977 standards. Estimates for single-race categories before 1999 included people who reported one race, or if they reported more than one race, identified one race as best representing their race. Differences between estimates tabulated using the two standards for data year 1999 are discussed in the footnotes for each NHIS table in Health, United States 2002, 2003, and 2004 editions, available from: https://www.cdc.gov/nchs/hus/previous.htm.

Race-Tables I and II illustrate NHIS data tabulated by race and Hispanic origin according to the 1997 and 1977 standards for two health statistics (cigarette smoking and private health insurance coverage). In these examples, three separate tabulations using the 1997 standards are shown: (a) race—mutually exclusive race groups, including several multiple-race combinations; (b) race, any mention—race groups that are not mutually exclusive because each race category includes all people who mention that race; and (c) race and Hispanic origin—detailed race and Hispanic origin with a multiple-race total category. Where applicable, comparison tabulations by race and Hispanic origin are shown based on the 1977 standards. Because the 1997 standards involve more race groups, the sample size of each race group under the 1997 standards is slightly smaller than the sample size under the 1977 standards. Only those few multiple-race groups with enough observations to meet standards of statistical reliability are shown. These tables also illustrate changes in labels and group categories resulting from the 1997 standards. The race designation “Black” is changed to “Black or African American,” the race designation “American Indian or Alaskan Native” is changed to “American Indian or Alaska Native,” and the ethnicity designation “Hispanic” is changed to “Hispanic or Latino.”

Survey data included in Health, United States, other than NHIS, the National Survey of Drug Use and Health (NSDUH), and the National Health and Nutrition Examination Survey (NHANES), generally do not permit tabulation of estimates for the detailed race and ethnicity categories shown in Race-Tables I and II, either because race data based on the 1997 standards categories are not yet available or because numbers of observations in certain subpopulation groups are insufficient to meet statistical reliability or confidentiality requirements.

For the 2000–2018 survey years, NHIS implemented hot-deck imputation of selected race and ethnicity variables. Starting with 2003 data, records for people for whom “Other race” was the only race response are treated as having missing data on race and added to the pool of records for which selected race and ethnicity variables are imputed. Before the 2000 NHIS, a crude imputation method was used that assigned a race to people with missing values for the variable MAINRACE (the respondent’s classification of the race they most identified with). Under these procedures, if an observed race was recorded by the interviewer, it was used to code a race value. If no race value was observed, all people who had a missing value for MAINRACE and were identified as Hispanic on the Hispanic-origin question were coded as White. In all other cases, non-Hispanic people were coded as “Other race.” Additional information on the NHIS methodology for imputing race and ethnicity is available from the survey description at: https://ftp.cdc.gov/pub/Health_Statistics/NCHS/Dataset_Documentation/NHIS/2012/srvydesc.pdf and from the NHIS race and Hispanic-origin website at: https://www.cdc.gov/nchs/nhis/rhoi.htm.

National Survey on Drug Use and Health (NSDUH)

Race-specific estimates based on NSDUH are tabulated using the 1997 standards. Estimates for specific race groups are shown when they meet requirements for statistical reliability and confidentiality. The race categories American Indian or Alaska Native only, Asian only, Black or African American only, Native Hawaiian or Other Pacific Islander only, and White only include people who reported only one racial group; the category of two or more races includes people who reported more than one of the five racial groups in the 1997 standards or one of the five racial groups and “some other race.”

(Also see Sources and Definitions, Hispanic origin; Population Census and Population Estimates.)

Race-Table I. Current cigarette smoking among adults aged 18 and over, by race and Hispanic origin under the 1997 and 1977 standards for classifying federal data on race and ethnicity: United States, average annual, 1993–1995

Race-Table I. Current cigarette smoking among adults aged 18 and over, by race and Hispanic origin under the 1997 and 1977 standards for classifying federal data on race and ethnicity: United States, average annual, 1993–1995
1997 standard Sample size Percent
(standard error)
1977 standard Sample size Percent
(standard error)
White only 46,228 25.2 (0.26) White 46,664 25.3 (0.26)
Black or African American only 7,208 26.6 (0.64) Black 7,334 26.5 (0.63)
American Indian or Alaska Native only 416 32.9 (2.53) American Indian or Alaskan Native 480 33.9 (2.38)
Asian only 1,370 15.0 (1.19) Asian or Pacific Islander 1,411 15.5 (1.22)
2 or more races total 786 34.5 (2.00)
    Black or African American; White 83 *21.7 (6.05)
    American Indian or Alaska Native; White 461 40.0 (2.58)
Race, any mention White, any mention 46,882 25.3 (0.26)
Black or African American, any mention 7,382 26.6 (0.63)
American Indian or Alaska Native, any mention 965 36.3 (1.71)
Asian, any mention 1,458 15.7 (1.20)
Native Hawaiian or Other Pacific Islander, any mention 53 *17.5 (5.10)
Hispanic origin and race Not Hispanic or Latino: Non-Hispanic:
    White only 42,421 25.8 (0.27)     White 42,976 25.9 (0.27)
    Black or African American only 7,053 26.7 (0.65)     Black 7,203 26.7 (0.64)
    American Indian or Alaska Native only 358 33.5 (2.69)     American Indian or Alaskan Native 407 35.4 (2.53)
    Asian only 1,320 14.8 (1.21)     Asian or Pacific Islander 1,397 15.3 (1.24)
    2 or more races total 687 35.6 (2.15)     …
Hispanic or Latino 5,175 17.8 (0.65) Hispanic 5,175 17.8 (0.65)

… Category not applicable.

* Estimate does not meet National Center for Health Statistics standards of reliability. Data preceded by an asterisk have a relative standard error of 20%–30%.

NOTES: The Office of Management and Budget’s (OMB) 1997 “Revisions to the Standards for the Classification of Federal Data on Race and Ethnicity” specifies five race groups (White, Black or African American, American Indian or Alaska Native, Asian, and Native Hawaiian or Other Pacific Islander) and allows respondents to report one or more race groups. Estimates for single- and multiple-race groups not shown do not meet standards for statistical reliability or confidentiality (relative standard error greater than 30%). Race groups under the 1997 standards are based on responses to the question, “What is the group or groups which represents [person’s] race?” For people who selected multiple groups, race groups under OMB’s 1977 “Race and Ethnic Standards for Federal Statistics and Administrative Reporting” were based on the additional question, “Which of those groups would you say best represents [person’s] race?” Race-specific estimates are calculated after excluding respondents of other and unknown race. Other published race-specific estimates are based on files in which such responses have been edited. Estimates are age adjusted to the year 2000 standard population using five age groups: 18–24, 25–34, 35–44, 45–64, and 65 and over. See Sources and Definitions, Age adjustment.

SOURCE: National Center for Health Statistics, National Health Interview Survey. See Sources and Definitions, National Health Interview Survey (NHIS).

Race-Table II. Private health care coverage among people under age 65, by race and Hispanic origin under 1997 and 1977 standards for classifying federal data on race and ethnicity: United States, average annual, 1993–1995

Race-Table II. Private health care coverage among people under age 65, by race and Hispanic origin under 1997 and 1977 standards for classifying federal data on race and ethnicity: United States, average annual, 1993–1995
1997 standard Sample size Percent
(standard error)
1977 standard Sample size Percent
(standard error)
White only 168,256 76.1 (0.28) White 170,472 75.9 (0.28)
Black or African American only 30,048 53.5 (0.63) Black 30,690 53.6 (0.63)
American Indian or Alaska Native only 2,003 44.2 (1.97) American Indian or Alaskan Native 2,316 43.5 (1.85)
Asian only 6,896 68.0 (1.39) Asian or Pacific Islander 7,146 68.2 (1.34)
Native Hawaiian or Other Pacific Islander only 173 75.0 (7.43)
2 or more races total 4,203 60.9 (1.17)
    Black or African American; White 686 59.5 (3.21)
    American Indian or Alaska Native; White 2,022 60.0 (1.71)
    Asian; White 590 71.9 (3.39)
    Native Hawaiian or Other Pacific Islander; White 56 59.2 (10.65)
Race, any mention White, any mention 171,817 75.8 (0.28)
Black or African American, any mention 31,147 53.6 (0.62)
American Indian or Alaska Native, any mention 4,365 52.4 (1.40)
Asian, any mention 7,639 68.4 (1.27)
Native Hawaiian or Other Pacific Islander, any mention 283 68.7 (6.23)
Hispanic origin and race Not Hispanic or Latino: 146,109 78.9 (0.27) Non-Hispanic: 149,057 78.6 (0.27)
    White only 29,250 53.9 (0.64)     White 29,877 54.0 (0.63)
    Black or African American only 1,620 45.2 (2.15)     Black 1,859 44.6 (2.05)
    American Indian or Alaska Native only 6,623 68.2 (1.43)     American Indian or Alaskan Native 6,999 68.4 (1.40)
    Asian only 145 76.4 (7.79)     Asian or Pacific Islander
    2 or more races total 3,365 62.6 (1.18)     …
Hispanic or Latino 31,040 48.8 (0.74) Hispanic 31,040 48.8 (0.74)

… Category not applicable.

NOTES: The Office of Management and Budget’s (OMB) 1997 “Revisions to the Standards for the Classification of Federal Data on Race and Ethnicity” specifies five race groups (White, Black or African American, American Indian or Alaska Native, Asian, and Native Hawaiian or Other Pacific Islander) and allows respondents to report one or more race groups. Estimates for single- and multiple-race groups not shown do not meet standards for statistical reliability or confidentiality (relative standard error greater than 30%). Race groups under the 1997 standards are based on responses to the question, “What is the group or groups which represents [person’s] race?” For people who selected multiple groups, race groups under OMB’s 1977 “Race and Ethnic Standards for Federal Statistics and Administrative Reporting” were based on responses to the additional question, “Which of those groups would you say best represents [person’s] race?” Race-specific estimates are calculated after excluding respondents of other and unknown race. Other published race-specific estimates are based on files in which such responses have been edited. Estimates are age adjusted to the year 2000 standard population using three age groups: under 18, 18–44, and 45–64. See Sources and Definitions, Age adjustment.

SOURCE: National Center for Health Statistics, National Health Interview Survey. See Sources and Definitions, National Health Interview Survey (NHIS).

Page last reviewed: August 12, 2022