Race and ethnicity data in the cardiac arrest registry to enhance survival: Insights from medicare self-reported data



      For out-of-hospital cardiac arrest (OHCA), assignment of race/ethnicity data can be challenging. Validation of race/ethnicity in registry data with patients’ self-reported race/ethnicity would provide insights regarding misclassification.


      Using recently linked 2013–2019 Cardiac Arrest Registry to Enhance Survival (CARES) data with Medicare files, we examined the concordance of race/ethnicity in CARES with self-reported race/ethnicity in Medicare. Among patients with unknown race/ethnicity in CARES, race/ethnicity data from Medicare files were reported.


      Of 26,875 patients in the linked data, 5757 (21.4%) had unknown race/ethnicity in CARES. Of the remaining 21,118 patients, 14,284 (67.6%) were identified in CARES as non-Hispanic White, 4771 (22.6%) as non-Hispanic Black, 1213 (5.7%) as Hispanic, 760 (3.6%) as Asian or Pacific Islander, and 90 (0.4%) as American Indian or Alaskan Native. The concordance rate for race/ethnicity between CARES and Medicare was 93.4% for patients reported as non-Hispanic White in CARES, 89.1% for non-Hispanic Blacks, 74.6% for Hispanics, 69.6% for Asians and Pacific Islanders, and 37.8% for American Indian or Alaskan Natives. For the 5757 patients with unknown race/ethnicity in CARES, 3973 (69.0%) self-reported in Medicare as non-Hispanic White, 617 (10.7%) as non-Hispanic Black, 425 (7.4%) as Hispanic, 491 (8.5%) as Asian or Pacific Islander, and 52 (0.9%) as American Indian or Alaskan Native. Race/ethnicity remained unknown in 199 (3.5%) of patients.


      Race/ethnicity in CARES was highly concordant with self-reported race/ethnicity in Medicare, especially for non-Hispanic White and Black individuals. For patients with unknown race/ethnicity data in CARES, the vast majority were of White race.


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        • Chan P.S.
        • McNally B.
        • Vellano K.
        • Tang Y.
        • Spertus J.A.
        Association of neighborhood race and income with survival after out-of-hospital cardiac arrest.
        J Am Heart Assoc. 2020; 9: e014178
        • McNally B.
        • Stokes A.
        • Crouch A.
        • Kellermann A.L.
        CARES: Cardiac arrest registry to enhance survival.
        Ann Emerg Med. 2009; 54: 674-683 e672
        • Hammill B.G.
        • Hernandez A.F.
        • Peterson E.D.
        • Fonarow G.C.
        • Schulman K.A.
        • Curtis L.H.
        Linking inpatient clinical registry data to Medicare claims data using indirect identifiers.
        Am Heart J. 2009; 157: 995-1000
        • Chan P.S.
        • Nallamothu B.K.
        • Krumholz H.K.
        • Spertus J.A.
        • Li Y.
        • Hammill B.G.
        • Curtis L.H.
        Long-term outcomes of elderly survivors of in-hospital cardiac arrest.
        N Engl J Med. 2013; 368: 1019-1026
        • Chan P.S.
        • McNally B.
        • Nallamothu B.K.
        • et al.
        Long-term outcomes among elderly survivors of out-of-hospital cardiac arrest.
        J Am Heart Assoc. 2016; 5: e002924
        • Chan P.S.
        • McNally B.
        • Chang A.
        • et al.
        Long term outcomes for out-of-hospital cardiac arrest in elderly patients: An analysis of cardiac arrest registry to enhance survival data linked to medicare files.
        Circ Cardiovasc Qual Outcomes. 2022; ([in press])
      1. U.S. Department of Health and Human Services. Office of Inspector General. Inaccuracies in medicare’s race and ethnicity data hinder the ability to assess health disparities June 2022. OEI-02-21-00100.