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.
References
CDC. National Electronic Telecommunications System for
Surveillance -- United States, 1990-1991. MMWR 1991;40:502-3.
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.
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.
Sumaya CV. Major infectious diseases causing excess morbidity in
the Hispanic population. Arch Intern Med 1991;151:1513-20.
CDC. Measles -- United States, 1990. MMWR 1991;40:369-72.
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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