Accurate collection and recording of high quality ethnicity data
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2004 Ethnicity Data Protocols Supplementary Notes On 1 July 2009 the ethnicity classification codes to be used in conjunction with the 2004 Ethnicity Data Protocols for the Health and Disability Sector (Protocols) will be updated to align with the Statistics New Zealand Statistical Standard for Ethnicity 2005 (2005 Standard). The objective of alignment is to ensure ethnicity is collected in accordance with Statistics New Zealand (SNZ) to allow comparability across government agencies and with the census. The purpose of these notes is to support the use of a consistent Ethnicity Classification codeset (codeset) across the whole Health and Disability System and to 1. Provide supplementary information to support the implementation of the codeset. 2. Provide guidance to the sector on the impact of the codeset changes to the input and output of ethnicity data. To ensure the Protocols align with the most current SNZ Ethnicity Standard, they will be updated and republished once SNZ have finalised the Ethnicity Standard to be used for the 2011 Census (expected late 2009/early 2010). The 2009 Ethnicity Classification Level Codes are published as separate Appendices so they can be easily inserted into existing copies of the Protocols. Background Accurate collection and recording of high quality ethnicity data ensures that the Government is able to track health trends by ethnicity and effectively monitor its performance to improve health outcomes and reduce health inequalities. It also provides Maori in particular with quality information about their health status and enables Maori to participate in, and contribute to, strategies for Maori health improvement. Ethnicity data informs the health and disability system about the health status of specific groups and enables the development and targeting of health services. Having a standard way to record, analyse and report on ethnicity data helps provide a high level of data quality. Service providers, managers, analysts and strategists can then have confidence in the data when they make decisions about health interventions. Ethnicity Data Protocols for the Health and Disability Sector (Protocols) describe procedures for the standardised collection, recording and output of ethnicity data within health information systems. The Ministry of Health (MOH) will implement changes as part of the 2009 National Collections Annual Maintenance Project (NCAMP) to information Page 1 systems, including the National Health Index (NHI), National Data Collections and reports that record and aggregate ethnicity codes at Level 2 and above. When should the NHI be updated? The NHI database should be updated if a healthcare user provides a more specific or different specific ethnicity than that already held for that person. 1 July 2009 codeset changes Ethnicity is recorded on the NHI and is submitted to National Data Collections using Level 2 ethnicity codes. Ethnicity is analysed and reported from National Data Collections at Level 0, Level 1 and Level 2. Alignment of the ‘Ethnicity Data Protocols for the Health and Disability Sector’ with the SNZ Standard at Level 2 is achieved through the following changes:Level 2 Ethnicity Codeset Addition of: Code ‘61’ - ‘Other ethnicity’. Code ‘94’ - ‘Don’t know’ Code ‘95’ - ‘Refused to Answer’ Code ’97’ - ’Response Unidentifiable’ The SNZ Standard guidelines for the use of these codes is as follows:Code ‘61’ – Other This category should be used to record the following ethnic response: Central American Indian Inuit North American Indian South American Indian Mauritian Seychelles Islander South African Coloured Code ‘94’ - Don't Know The use of this category is necessary when the respondent is unsure of their ethnic group in an interviewer administered survey (i.e. asked verbally) or writes this in as a response. Code ‘95’ - Refused to Answer This category is only used when it is known that the respondent has purposefully chosen not to respond to the question. Its use is most applicable in face-to-face or telephone interviews, but may be used in self-completed questionnaires if the respondent has clearly indicated they refuse or object to answering the question. Page 2 97 - Response Unidentifiable This category is used when there is a response given, but the response is illegible, or it is unclear what the meaning or intent of the response is - this most commonly occurs when the response being classified contains insufficient detail, is ambiguous or is vague. Where possible, code 54 should be made inactive from selection in any ethnicity list in a patient administration/management system to minimise the likelihood of its future selection. If it is not possible to make the list item inactive, then modification of the ethnicity description should discourage its future use:Modify ethnicity description of: Code ‘54’ – ‘Other’ to Code ‘54’ – ‘zz Do Not Use (Other Retired)’ The suggested description used when reporting ethnicity at Level 2 is Code ‘54’ – ‘Other (Retired)’ Level 0 and Level 1 Ethnicity Classification Groupings The SNZ classification structure no longer contains a Level 0 but this level is used as an output category for many health and disability statistics. Where information systems group ethnicity there are no changes to the Level 0 codeset. Alignment of the ‘Ethnicity Data Protocols for the Health and Disability Sector’ with the SNZ Standard at Level 1 is achieved with the following codeset changes:Level 1 Addition of : • Code 6 - ‘Other’ Modification of description • Code 5 – ‘Other ethnic groups’ To • Code 5 – ‘‘Middle Eastern/Latin American and African’ (MELAA)’ Collection of Ethnicity Data Protocol requirements for ethnicity data collection are: The standard ethnicity question for the health and disability sector is the Statistics New Zealand 2001 Census ethnicity question (with no changes to format, font size or dimensions). A proxy response should be used where a respondent is unable to fill in a form or questionnaire themselves. Page 3 The respondent must identify their own ethnicity and the collector should not guess ethnicity on behalf of the respondent Standardised ethnicity recording Protocol requirements for ethnicity data recording are: The Protocols define the ethnicity codes standard text descriptions to be used to store ethnicity in health information systems. Ethnicity must be recorded at Level 2 as the minimum level of specificity. Any recording system must be capable of recording a minimum of three ethnicities A prioritisation process must be followed if more than three ethnicities are given. How to classify the ‘New Zealander’ response When a respondent has entered ‘New Zealander’ or ‘Kiwi’ in the free text space on the ethnicity question, the current practice is to classify this response as ‘NZ European’. The SNZ 2005 Standard changed the classification of this response. However, SNZ are currently reviewing their classification of the ‘New Zealander’ response in preparation for the 2011 census. Continue to follow the current practice of classifying the ‘New Zealander’ response as NZ European. Where a respondent gives multiple ethnicity responses use the prioritisation system outlined in the Protocols. What is the impact of 2009 codeset changes to outputting ethnicity data? Government, analysts and researchers will need to be aware of the impact of 1 July 2009 codeset changes on the way that historical data is compared and reported at Level 1. The SNZ 2005 Standard states “Level one data is not comparable to previous level one data with the introduction of the level one groups, ‘Middle Eastern, Latin American and African’ (MELAA) and Other Ethnicity.” It is recognised that it will take time for the sector to implement and align ethnicity data with the SNZ Standard. National Data Collections will not reject ethnicity data submitted as Code 54 (Other ethnicity). Level 1 output From 1 July 2009 health systems and data, with the exception of Code 54 (Other), Level 2 ethnicity codes starting with ‘5’ will be reported as ‘MELAA’, Code 5 at Level 1. Page 4 Code 61 (Other ethnicity) and Code 54 will be reported as ‘Other ethnicity’, Code 6 at Level 1. Page 5 APPENDIX Summary of Proposed Codeset Changes to align Ethnicity Data Protocols for the Health & Disability Sector with Statistics New Zealand Statistical Standard for Ethnicity 2005 Level 1 Codeset Changes Current State Five Level 1 Codes (1, 2, 3, 4, 5) Proposed Change Seven Level 1 Codes (1, 2, 3, 4, 5, 6, 9) Code 5 = Middle Eastern/Latin American/African Change to the meaning of Code 5 Addition of: Code 6 – Other Ethnicity Code 9 – Residual Categories* Code 5 = Other ethnic Groups *The Ministry of Health currently uses Code 9 at Level 1 in National Data Collection reporting but Code 9 is not in the Ethnicity Data Protocols. Level 2 Codeset Changes Current State Twenty Five Level 2 Codes (3 not used in MOH Systems) Code 54 - Other Proposed Change Twenty Seven Level 2 Codes (2 not used in MOH Systems) Retire Code 54 Residual Codes Code 96 – Repeated Value (Not Used) Code 97 – Response Unidentifiable (Not Used) Code 98 – Response Outside Scope (Not Used) Code 99 – Not Stated Addition of: Code 61 – Other Ethnicity Addition of: Code 94 – Don’t Know Code 95 – Refused to Answer Code 97 – Response Unidentifiable Page 6 Level 3 Codeset Changes Current State Forty one Level 3 Codes (three not used in MOH Systems) Code 120 – Other European NFD Proposed Change Forty two Level 3 Codes (two not used in MOH Systems) Retire Code 120 Code 541 - Other Retire Code 541 Addition of: Code 611 – Other Ethnicity Addition of: Code 944 – Don’t Know Code 955 – Refused to Answer Residual Codes Code 966 – Repeated Value (Not Used) Code 977 – Response Unidentifiable (Not Used) Introduce use of: Code 988 – Response Outside Scope Code 977 – Response Unidentifiable (Not Used) Code 999 – Not Stated Page 7 Level 4 Codeset Changes Current State Two hundred and thirty one Level 4 codes (three not used in MOH Systems) Code 12100 – Other European NFD Code 37100 – Other Pacific Peoples NFD Code 53111 - Black Code 54100 – Other NFD Proposed Change Two hundred and thirty nine Level 4 codes (two not used in MOH Systems) Retire Code 12100 Code 37100 Code 53111 Code 54100 Code 12111 – Celtic Code 12111 – Celtic NFD (Description Change) Addition of: 12516 – Bosnian 12949 – Afrikaner 12950 – Zimbabwean 43117 – Anglo Indian 44416 – Eurasian 53120 – Eritrean 53121 – Ethiopian 53122 – Ghanaian 53199 – African nec 61111 – Central American Indian 61112 – Inuit 61113 – North American Indian 61114 – South American Indian 61115 – Mauritian 61116 – Seychelles Islander 61117 – South African Coloured 61118 – New Zealander 61199 – Other Ethnicity nec Additional Residual Codes: Code 94444 – Don’t Know Code 95555 – Refused to Answer Existing Residual Codes Code 96666 – Repeated Value (Not Used) Code 97777 – Response Unidentifiable (Not Used) Code 98888 – Response Outside Scope (Not Used) Code 999 – Not Stated Introduction of use of Code 97777 – Response Unidentifiable Page 8 2009 Protocols Prioritisation for Level 2 Priority order 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 94 95 97 99 Ethnic group code (L2) 21 35 36 34 33 32 31 37 30 41 43 42 44 40 52 53 51 61 54 12 10 11 94 95 97 99 Ethnic group code description Maori Tokelauan Fijian Niuean Tongan Cook Island Maori Samoan Other Pacific Peoples Pacific Peoples not further defined Southeast Asian Indian Chinese Other Asian Asian not further defined Latin American / Hispanic African (or cultural group of African origin) Middle Eastern Other Ethnicity Other Other European European not further defined New Zealand European Don’t Know Refused to Answer Response Unidentifiable Not stated Page 9 Republish the Appendices (as per 2004 EDP) Level one Code 1 2 3 4 5 6 9 Description European Maori Pacific Peoples Asian Middle Eastern/Latin American/African Other ethnicity Residual Categories Level two Code 10 11 12 21 30 31 32 33 34 35 36 37 40 41 42 43 44 51 52 53 61 94 95 97 99 Description European nfd New Zealand European Other European Maori Pacific Peoples nfd Samoan Cook Islands Maori Tongan Niuean Tokelauan Fijian Other Pacific Peoples Asian nfd Southeast Asian Chinese Indian Other Asian Middle Eastern Latin American African Other ethnicity Don’t Know Refused to Answer Response Unidentifiable Not Stated Page 10 Level three Code 100 111 120 121 122 123 124 125 126 127 128 129 211 300 311 321 331 341 351 361 371 400 410 411 412 413 414 421 431 441 442 443 444 511 521 531 611 944 955 977 999 Description European nfd New Zealand European Other European nfd British and Irish Dutch Greek Polish South Slav Italian German Australian Other European Maori Pacific Peoples nfd Samoan Cook Islands Maori Tongan Niuean Tokelauan Fijian Other Pacific Peoples Asian nfd Southeast Asian nfd Fillipino Cambodian Vietnamese Other Southeast Asian Chinese Indian Sri Lankan Japanese Korean Other Asian Middle Eastern Latin American / Hispanic African Other Ethnicity Don’t Know Refused to Answer Response Unidentifiable Not Stated Page 11 Level 4 Code 10000 11111 12000 12100 12111 12112 12113 12114 12115 12116 12117 12118 12119 12120 12121 12199 12211 12311 12411 12500 12511 12512 12513 12514 12515 12599 12611 12711 12811 12911 12912 12913 12914 12915 12916 12917 12918 12919 12920 12921 12922 12923 12924 Description European NFD New Zealand European Other European NFD British NFD Celtic Channel Islander Cornish English Gaelic Irish Manx Orkney Islander Scottish (Scots) Shetland Islander Welsh British NEC Dutch/Netherlands Greek (including Greek Cypriot) Polish South Slav (formerly Yugoslav groups) NFD Croat/Croatian Dalmatian Macedonian Serb/Serbian Slovene/Slovenian South Slav (formerly Yugoslav groups) NEC Italian German Australian Albanian Armenian Austrian Belgian Bulgarian Belorussian Corsican Cypriot Unspecified Czech Danish Estonian Finnish Flemish French Page 12 Code 12925 12926 12927 12928 12929 12930 12931 12932 12933 12934 12935 12936 12937 12938 12939 12940 12941 12942 12943 12944 12945 12946 12947 12948 12949 12950 12999 21111 30000 31111 32100 32111 32112 32113 32114 32115 32116 32117 32118 32119 32120 32121 33111 34111 35111 36111 37111 Description Greenlander Hungarian Icelander Latvian Lithuanian Maltese Norwegian Portuguese Romanian / Rumanian Romany / Gypsy Russian Sardinian Slavic / Slav Slovak Spanish Swedish Swiss Ukrainian American (US) Burgher Canadian Falkland Islander / Kelper New Caledonian South African Afrikaner Zimbabwean European NEC Maori Pacific peoples NFD Samoan Cook Island Maori NFD Aitutaki Islander Atiu Islander Mangaia Islander Manihiki Islander Mauke Islander Mitiaro Islander Palmerston Islander Penrhyn Islander Pukapuka Islander Rakahanga Islander Rarotongan Tongan Niuean Tokelauan Fijian (except Fiji Indian / Indo-Fijian) Admiralty Islander Page 13 Code 37112 37113 37114 37115 37116 37117 37118 37119 37120 37121 37122 37123 37124 37125 37126 37127 37128 37129 37130 37131 37132 37133 37134 37135 37136 37137 37138 37139 37140 37141 37142 37143 37144 37145 37146 37147 37148 37199 40000 41000 41111 41211 41311 41411 41412 Description Australian Aboriginal Austral Islander Belau / Palau Islander Bismark Archipelagoan Bougainvillean Caroline Islander Easter Islander Gambier Islander Guadalcanalian Guam Islander / Chamorro Hawaiian Kanaka / Kanak I-Kiribati / Gilbertese Malaitian Manus Islander Marianas Islander Marquesas Islander Marshall Islander Nauru Islander New Britain Islander New Georgian New Irelander Ocean Islander / Banaban Papuan / New Guinean / Irian Jayan Phoenix Islander Pitcairn Islander Rotuman / Rotuman Islander Santa Cruz Islander Society Islander (including Tahitian) Solomon Islander Torres Strait Islander / Thursday Islander Tuamotu Islander Tuvalu Islander / Ellice Islander Vanuatu Islander / New Hebridean Wake Islander Wallis Islander Yap Islander Other Pacific peoples NEC Asian NFD Southeast Asian NFD Filipino Khmer / Kampuchean / Cambodian Vietnamese Burmese Indonesian (including Javanese / Sundanese / Sumatran) Page 14 Code 41413 41414 41415 41499 42100 42111 42112 42113 42114 42115 42116 42199 43100 43111 43112 43113 43114 43115 43116 43117 43199 44100 44111 44112 44199 44211 44311 44411 44412 44413 44414 44415 44499 51100 51111 51112 51113 51114 51115 51116 51117 51118 51119 51120 51121 51122 51123 Description Lao / Laotian Malay / Malayan Thai / Tai / Siamese Other Southeast Asian NEC Chinese NFD Hong Kong Chinese Kampuchean Chinese Malaysian Chinese Singaporean Chinese Vietnamese Chinese Taiwanese Chinese Chinese NEC Indian NFD Bengali Fijian Indian / Indo-Fijian Gujarati Tamil Punjabi Sikh Anglo Indian Indian NEC Sri Lankan NFD Sinhalese Sri Lankan Tamil Sri Lankan NEC Japanese Korean Afghani Bangladeshi Nepalese Pakistani Tibetan Other Asian NEC Middle Eastern NFD Algerian Arab Assyrian Egyptian Iranian / Persian Iraqi Israeli / Jewish / Hebrew Jordanian Kurd Lebanese Libyan Moroccan Omani Page 15 Code 51124 51125 51126 51127 51128 51199 52100 52111 52112 52113 52114 52115 52116 52117 52118 52119 52120 52121 52122 52123 52124 52125 52126 52127 52128 52129 52130 52199 53100 53112 53113 53114 53115 53116 53117 53118 53119 53120 53121 53122 53199 61111 61112 61115 61113 61116 Description Palestinian Syrian Tunisian Turkish (including Turkish Cypriot) Yemeni Middle Eastern NEC Latin American / Hispanic NFD Argentinian Bolivian Brazilian Chilean Colombian Costa Rican Creole (Latin America) Ecuadorian Guatemalan Guyanese Honduran Malvinian (Spanish-speaking Falkland Islander) Mexican Nicaraguan Panamanian Paraguayan Peruvian Puerto Rican Uruguayan Venezuelan Latin American / Hispanic NEC African NFD Creole (US) Jamaican Kenyan Nigerian African American Ugandan West Indian / Caribbean Somali Eritrean Ethiopian Ghanian Other African NEC Central American Indian Inuit / Eskimo Mauritian North American Indian Seychelles Islander Page 16 Code 61114 61117 61118 61199 94444 95555 97777 99999 Description South American Indian South African Coloured New Zealander Other NEC Don't Know Refused to Answer Response unidentifiable Not stated Page 17
