Validity of ethnicity recording in the maternity clinical
administration system in NHS Lothian, Scotland
Dr Fatim Lakha
Mr Andrew Massie
Dr Dermot Gorman
Outline of presentation
• Background
• Aims
• Methods
• Classification
• Results
• Conclusions and next steps
Background
• Health experiences, care & management of different ethnic groups vary
• Reduction in inequalities is a priority – 2010 Equality Act (UK)– 2010 Healthcare Quality Strategy Scotland
• NHS is striving to collect routine ethnicity data in a standardised way
• The accuracy of this data recording has not been validated to date
Aims
• To evaluate the completeness & validity of ethnicity recording in the maternity administration system
• To assess if could describe use/need for interpretation services by ethnic group alone and/or in conjunction with other data
Annual completion rates of ethnicity data in the maternity clinical administration system
NHS Lothian (maternity Trak)
Year Ethnicity recording completion rate
2009 52%
2010 86%
2011 93%
2012
2013
2014 (to end Oct)
97%
97%
97%
Methods (1)
• Maternity TRAK – records self assigned ethnicity plus ‘preferred language and need for an interpreter – data collected by a midwife in early pregnancy
• National Records Scotland records for all live births in 2012 (birth certificates) – mother’s country of birth – on official registration of the birth
• The two datasets were linked
Methods (2)
• For both datasets each individual record was assigned to one of 13 classification groups
• Sensitivity, specificity, PPV and NPV calculated• Explored use/need for interpreter by ethnicity
alone and with preferred language.
Geographical classification groups
• African• Australasian• Caribbean• East Asian• Eastern Europe• European other• Middle East
• North American• South American• South Asian• UK• Other• Refusal/unknown
Results
Validity of Maternity TRAK ethnicity data
Explaining the reduced sensitivity of ethnicity to ‘country of birth’
Validity of Maternity TRAK ethnicity data
How does TRAK ethnicity match to NRS country of birth?
Can ethnicity be a guide to interpreter requirements?
Preferred language and interpreter requirement for self-reported ‘South Asians’
Preferred language and interpreter requirement for self-reported ‘Eastern
Europeans’ (n=611)
Strengths
1.High levels of completeness2.Accurate recording by staff – staff training etc has helped and mandatory now so very helpful3.able to classify individuals into 13 classification groups thus then easy to compare NRS with mat trak4.NRS registration is mandatory and the MCOB is 100%
Limitations
1.NRS data incomplete for December - This led to reduced matching and sample size.2.Too many ethnicity options in maternity trak
Conclusions
• Ethnicity data is very completely & accurately recorded by maternity staff
• Differences in ‘meaning’ between terms ethnicity/nationality/CoB must be understood & interpreted in light of known national migration patterns
• Ethnicity & CoB data are important in examining access and equity of service provision – which is best to use depends on the subject and may require additional data such as preferred language.
Next stepsDisseminate findings and link with the Edinburgh Health and Ethnicity research group
Consider a simplified menu of ethnicity choices on maternity Trak
Undertake further work to address concerns that needs for interpretation/translation are not being adequately met
Maternity trak ethnicity is being used to:•Interpreter provision in maternity care•Ensure equity of provision of an intervention to improve access to postnatal contraceptive services•Audit of FGM care
Acknowledgements
• Niall Blackie for supplying the 2012 maternity TRAK data
• NRS for supplying the 2012 birth registrations• Dr Vittal Katikireddi• Ms Echo Lian for linking the two datasets• Additional Needs and Diversity Information
Task Force (ANDI TF) Chair Prof Bhopal – has led improvements in Lothian’s ethnicity recording
Births by ethnic group over time