Race

Recent vital statistics data in Health, United States are presented for the following six race and Hispanic-origin groups: American Indian and Alaska Native non-Hispanic, Asian non-Hispanic, Black or African American non-Hispanic, Native Hawaiian or Other Pacific Islander non-Hispanic, White non-Hispanic, and Hispanic. 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.

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 and 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 Hispanic origin in Health, United States have implemented the “Revisions to the Standards for the Classification of Federal Data on Race and Ethnicity.” The 1997 standards allow for observer or proxy identification of race but clearly state a preference for self-classification. The 1997 standards call for the federal government’s data systems to classify people into the following groups: American Indian and Alaska Native, Asian, Black or African American, Native Hawaiian or Other Pacific Islander, White, and Hispanic. The Asian or Pacific Islander race group proposed in the 1977 standards was split into two 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. Generally, a small percentage of people report two or more races (an estimated 3.0% of the population in 2022). 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 single-race approach), or as those who reported Black regardless of whether they also reported another race. In Health, United States, indicators present data using the single-race approach, but this should not imply that it is the preferred method of presenting or analyzing data.

Estimates for race groups based on the 1997 standards are not completely comparable with estimates 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.

Starting with 1999 data, most National Center for Health Statistics (NCHS) survey estimates by race are presented based on the 1997 standards. Vital statistics systems, however, transitioned to the 1997 standards gradually over time as states adopted the 2003 revisions 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 time, most race data for vital statistics used the 1977 standards. During the transition, vital records data were made comparable across states with population data collected under the 1997 standards 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.

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. Beginning with 1980 data, 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 standards allowing the reporting of more than one race (multiple races). In 2022, 2.9% of mothers in the 50 states and District of Columbia (D.C.) reported more than one race. If the race of the mother is not reported, the race of the father is assigned to the mother. If race information is not reported for either parent, the race of the mother is imputed from the race of the mother on the preceding birth record with a known race of mother. In 2022, race of mother was imputed for 7.6% of births (by occurrence). Until all states adopted the 2003 revision and the 1997 standards, both numerators and denominators were 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 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 and the User Guide to the 2022 Natality Public Use File.

Fetal death data set

The 2003 revision of the U.S. Standard Report of Fetal Death allows the reporting of the five race categories either alone (single race) or in combination (more than one race or multiple races) for the mother according to the 1997 “Revisions to the Standards for the Classification of Federal Data on Race and Ethnicity.” Starting in 2018, all 50 states and the District of Columbia, Puerto Rico, Guam, Northern Marianas, and U.S. Virgin Islands began reporting race according to the 1997 standards. Before 2018, to provide uniformity and comparability of the data while states transitioned to the 1997 standards, it was necessary to “bridge” the responses of those for whom more than one race was reported (multiple race) to one single race. Fetal death data for race groups for 2018 and beyond are not completely comparable with earlier data. Bridged-race data are no longer available on the public-use file beginning with the 2020 data year.

Linked birth/infant death data set

Information about the infant’s race and Hispanic origin is based on the race and Hispanic origin of the mother, which is provided by the mother at the time of birth and recorded on the birth certificate. The 2003 revision of the U.S Standard Certificate of Live Birth uses revised race and ethnicity sections conforming to the 1997 “Revisions to the Standards for the Classification of Federal Data on Race and Ethnicity.” Starting in 2016, all birth records moved to the 1997 standards. However, because an infant death may be linked to a birth that occurred in the previous year, linked data are not based on the 1997 standards until 2017. Before 2017, to provide uniformity and comparability of the data while states transitioned to the 1997 standards, it was necessary to “bridge” the responses of those for whom more than one race was reported (multiple race) to one single race. Linked data for race groups for 2017 and beyond are not completely comparable with earlier data. Interpretation of trend data should take into consideration changes to reporting areas and standards. Bridged-race data are no longer available on the public-use file beginning with the 2020 data year.

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 Hispanic-origin information from the census is obtained through 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 and 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 and 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.

The accuracy of race and Hispanic-origin reporting on the death certificate is very high for the White and Black populations. Accuracy remains low for the American Indian and Alaska Native population, but it is reasonably high 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 race and Hispanic origin reporting on the death certificate. The main consequence of race and Hispanic origin misclassification is an underestimation of mortality for the affected population: death rates are underestimated by 3% for both the Hispanic and non-Hispanic Asian populations and by 34% for the non-Hispanic American Indian and Alaska Native population. Correction for death certificate misclassification of race and Hispanic origin reverses the ratio of non-Hispanic American Indian and Alaska Native to non-Hispanic White mortality from a large minority-over-majority advantage to a relatively large disadvantage for non-Hispanic American Indian and Alaska Native populations. In the Hispanic and Asian or Pacific Islander populations, correction for death certificate race and Hispanic origin misclassification has a minimal effect on the minority-majority mortality ratio. For more information, see: The validity of race and Hispanic-origin reporting on death certificates in the United States: An update; and The validity of race and Hispanic origin reporting on death certificates in the United States.

Issues affecting the interpretation of vital event rates for the American Indian and Alaska Native population include (a) changes in the classification or self-identification of people of American Indian and Alaska Native heritage over time, and (b) misclassification of American Indian and Alaska Native people on death certificates by the funeral director or informant. Vital event rates for the American Indian and Alaska Native population shown in Health, United States are based on the total U.S. resident American Indian and 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-level data for American Indian and Alaska Native people who reside on or near reservations. Because of misclassification of American Indian and Alaska Native people on death certificates, American Indian and 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 in 2003, some states began using the 2003 revision of the U.S. Standard Certificate of Death, which incorporates the 1997 Office of Management and Budget “Revisions to the Standards for the Classification of Federal Data on Race and Ethnicity.” The 1997 standards allow the reporting of more than one race (multiple races). In 2022, 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 standards, both numerators and denominators were bridged to the 1977 standards. Starting in 2018, all states and D.C. report deaths using the 2003 revision of the death certificate and report race according to the 1997 standards. For more information, see: NCHS procedures for multiple-race and Hispanic-origin data: Collection, coding, editing, and transmitting; and Vital statistics of the United States, vol II, Mortality, part A, Mortality Technical Appendices.

National Health and Nutrition Examination Survey (NHANES)

Race-specific estimates based on NHANES are tabulated using the 1997 standards for data years 1999 and beyond. Before 1999 data, the 1977 standards were used. Because of the differences between the two standards, the race-specific estimates shown in data sets presenting NHANES data for 1999 and beyond are not strictly comparable with estimates for earlier data years. Race in NHANES I (1971–1974) and II (1976–1980) was determined primarily by interviewer observation; starting with NHANES III (1988–1994), race is self-reported by survey participants.

The NHANES sample for data years 1999–2006 was designed to provide estimates specifically for people of Mexican origin and not for all Hispanic-origin people in the United States. Starting with 2007–2008 data, all Hispanic people were oversampled and oversampling of the Black population continued. Starting in 2011, NHANES also oversampled the non-Hispanic Asian population. In Health, United States, estimates are shown for Black non-Hispanic, White non-Hispanic, and Mexican-origin people, as well as for Asian non-Hispanic and Hispanic-origin people, where possible. Although data are collected according to the 1997 standards, numbers of observations are insufficient during this period to meet statistical reliability or confidentiality requirements for reporting estimates for additional race categories.

National Health Interview Survey (NHIS)

Race-specific estimates based on NHIS are 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 and 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 Hispanic origin, 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, race 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.

Race-Tables I and II show 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 include 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 multiple-race groups with enough observations to meet standards of statistical reliability are shown. These tables also show changes in labels and group categories resulting from the 1997 standards. The race designation “Black” changed to “Black or African American,” the race designation “American Indian or Alaskan Native” changed to “American Indian or Alaska Native,” and the Hispanic-origin designation “Hispanic” changed to “Hispanic or Latino.”

Survey data included in Health, United States, other than NHIS, the National Survey on Drug Use and Health, and the National Health and Nutrition Examination Survey, generally do not permit tabulation of estimates for the detailed race and Hispanic-origin 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.

Starting with survey year 2019, NHIS does not impute race or Hispanic-origin variables. For the 2000–2018 survey years, NHIS implemented hot-deck imputation of missing selected race and Hispanic-origin variables. For the 2003–2018 survey years, records of people for whom Other race was the only race response were treated as having missing data on race and added to the pool of records for which selected race and Hispanic-origin variables were imputed. Before the 2000 NHIS, a crude imputation method that assigned a race to people with missing values for the variable MAINRACE (the respondent’s classification of the race they most identified with) was used. 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 Hispanic origin is available from the survey description and from the NHIS race and Hispanic-origin website.

National Survey on Drug Use and Health (NSDUH) (last updated in June 2023)

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 and 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 ages 18 and older, 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 II. Private healthcare coverage among people younger than 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