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Imputing Missing Race/Ethnicity in Pediatric Electronic Health Records: Reducing Bias with Use of U.S. Census

Robert W Grundmeier1, Lihai Song1, Mark J Ramos1

  • 1The Children's Hospital of Philadelphia, Philadelphia, PA.

Health Services Research
|March 12, 2015
PubMed

Insights

Imputing missing race/ethnicity data using U.S. Census information, including address and surname, significantly reduced bias in pediatric health studies. This method improves data accuracy compared to traditional missing data techniques.

Area of Science:

  • Health Informatics
  • Biostatistics
  • Pediatric Research

Background:

  • Accurate race/ethnicity data is crucial for understanding health disparities in pediatric populations.
  • Missing race/ethnicity data can introduce bias into research findings.
  • Standard methods for handling missing data may not adequately address nonrandom missingness.

Purpose of the Study:

  • To evaluate the effectiveness of imputing race/ethnicity using U.S. Census data (address, surname) compared to conventional missing data techniques.
  • To assess the utility of this novel imputation method in a pediatric cohort.
  • To determine if incorporating U.S. Census information reduces bias in outcomes.

Main Methods:

  • Utilized electronic health record data from 30 pediatric practices.
  • Conducted a simulation experiment with dichotomous and continuous outcomes, introducing nonrandom missingness for race/ethnicity.
  • Compared multiple imputation with U.S. Census data (address, surname) against standard methods (multiple imputation with clinical factors, complete case analysis, indicator variables).

Main Results:

  • Imputation incorporating U.S. Census information demonstrated a reduction in bias for both continuous and dichotomous outcomes.
  • The novel imputation method proved more effective than standard approaches in mitigating bias caused by nonrandomly missing race/ethnicity data.

Conclusions:

  • Imputing race/ethnicity using U.S. Census data (address, surname) is a valuable method for reducing bias in pediatric research.
  • This approach is particularly beneficial when race/ethnicity data is partially and nonrandomly missing.
  • The findings support the use of Census-derived data for improving the accuracy of race/ethnicity information in health research.
Abstract

Keywords:
Multiple imputationU.S. Census location and surname datahealth disparitiesrace and ethnicity

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