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Racial and Ethnic Health Disparities"],"published-print":{"date-parts":[[2026,4]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Unequal disease burdens such as SARS-CoV-2 infection rates and COVID-19 outcomes across race\/ethnicity groups have been reported. Misclassification of and missing race and ethnicity (race\/ethnicity) data hinder efforts to identify and address health disparities in the US Military Health System (MHS); therefore, we evaluated the statistical accuracy of administratively recorded race\/ethnicity data in the MHS Data Repository (MDR) through comparison to self-reported race\/ethnicity collected via questionnaire in the Epidemiology, Immunology, and Clinical Characteristics of Emerging Infectious Diseases with Pandemic Potential (EPICC) cohort study.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>The study population included 6009 active duty\/retired military (AD\/R) and dependent beneficiaries (DB). Considering EPICC study responses the \u201cgold standard,\u201d we calculated sensitivity and positive predictive value (PPV) by race\/ethnicity category (non-Hispanic (NH) White, NH Black, Hispanic, NH Asian\/Pacific Islander (A\/PI), NH American Indian\/Alaskan Native (AI\/AN), NH Other, missing\/unknown).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Among AD\/R, the highest sensitivity and PPV values were for NH White (0.93, 0.96), NH Black (0.90, 0.92), Hispanic (0.80, 0.93), and NH A\/PI (0.84, 0.95) and lowest for NH AI\/AN (0.62, 0.57) and NH Other (0.09, 0.03). The MDR was missing race\/ethnicity data for approximately 63% of DB and sensitivity values, though not PPV, were comparatively much lower: NH White (0.35, 0.88), NH Black (0.55, 0.89), Hispanic (0.13, 1.00), and NH A\/PI (0.28, 0.84).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Our evaluation of MDR race\/ethnicity data revealed misclassification, particularly among some minority groups, and substantial missingness among DB. The potential bias introduced impacts the ability to address health disparities and conduct health research in the MHS, including studies of COVID-19, and needs further examination.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s40615-025-02351-7","type":"journal-article","created":{"date-parts":[[2025,3,22]],"date-time":"2025-03-22T20:42:17Z","timestamp":1742676137000},"page":"1513-1526","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Statistical Accuracy of Administratively Recorded Race\/Ethnicity in the Military Health System and Race\/Ethnicity Ascertained via Questionnaire"],"prefix":"10.1007","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9905-6001","authenticated-orcid":false,"given":"Jordan","family":"McAdam","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0530-384X","authenticated-orcid":false,"given":"Stephanie A.","family":"Richard","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2734-4511","authenticated-orcid":false,"given":"Cara H.","family":"Olsen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8289-4252","authenticated-orcid":false,"given":"Celia","family":"Byrne","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shawn","family":"Clausen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amber","family":"Michel","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5114-1669","authenticated-orcid":false,"given":"Brian K.","family":"Agan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert","family":"O\u2019Connell","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Timothy H.","family":"Burgess","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3077-9505","authenticated-orcid":false,"given":"David R.","family":"Tribble","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Simon","family":"Pollett","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0717-8202","authenticated-orcid":false,"given":"James D.","family":"Mancuso","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3881-8695","authenticated-orcid":false,"given":"Jennifer A.","family":"Rusiecki","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,3,21]]},"reference":[{"issue":"5 pt 2","key":"2351_CR1","doi-asserted-by":"publisher","first-page":"1658","DOI":"10.1111\/j.1475-6773.2005.00449.x","volume":"40","author":"ME Ford","year":"2005","unstructured":"Ford ME, Kelly PA. 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Jackson Foundation (HJF) were funded under a Cooperative Research and Development Agreement to conduct an unrelated phase III COVID-19 monoclonal antibody immunoprophylaxis trial sponsored by AstraZeneca. The HJF, in support of the USU IDCRP, was funded by the Department of Defense Joint Program Executive Office for Chemical, Biological, Radiological, and Nuclear Defense to augment the conduct of an unrelated phase III vaccine trial sponsored by AstraZeneca. Both trials were part of the US Government COVID-19 response. Neither is related to the work presented here. The other co-authors have nothing to declare.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of Interest"}},{"value":"All opinions expressed here are the authors\u2019 and do not necessarily reflect the policies and official views of the Uniformed Services University of the Health Sciences or the Department of Defense. The contents of this publication are the sole responsibility of the author(s) and do not necessarily reflect the views, opinions, or policies of Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc. (HJF), Uniformed Services University of the Health Sciences (USUHS), the Department of Defense (DoD), the Departments of the Army, Navy, or Air Force, or the Defense Health Agency. Mention of trade names, commercial products, or organizations does not imply endorsement by the US Government.CHO, SC, CB, RO, THB, DRT, JDM and JAR are service members or employees of the US Government. This work was prepared as part of their official duties. Title 17 U.S.C. \u00a7105 provides that \u201cCopyright protection under this title is not available for any work of the United States Government.\u201d Title 17 U.S.C. \u00a7101 defines a U.S. Government work as a work prepared by a military service member or employee of the US Government as part of that person\u2019s official duties.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Disclaimer"}},{"value":"Brooke Army Medical Center, Fort Sam Houston, TX: T. MerrittNaval Medical Center San Diego, San Diego, CA: C. Berjohn, Ryan C. Maves.Uniformed Services University of the Health Sciences, Bethesda, MD: M. FritschlanskiUnited States Air Force School of Aerospace Medicine, Dayton, OH: R. Chapleau","order":5,"name":"Ethics","group":{"name":"EthicsHeading","label":"The following EPICC Study Team Members are Listed as Group Authors for this Paper"}}]}}