Monitoring Multiracial Patients in the Health Care System

Some health care systems use outdated approaches to racial categorization that obscure care disparities.

A new study suggests that multiracial individuals who change their status from a single race to multiracial over time may be healthier than their monoracial-identifying counterparts.

Despite the rapidly growing population of multiracial individuals in the United States, researchers and health care systems continue to see the use of outdated approaches to racial categorization that force people to identify as monoracial.

This could be masking the frequency of health conditions and obscuring disparities in health care access and utilization among multiracial populations.

Karen M. Tabb Dina is a social work professor and also the lead author of 2 recent studies that analyzed issues of racial identity and its impact on health care access and utilization among a cohort of nearly 8000 young US citizens.

Participants in the Adolescent Health survey were asked questions about their racial background during the first round of data collection in 1994 and again during a third round in 2002. Only 7% of participants identified as multiracial at either round, and of those only 20% selected the same racial categories both times, according to Tabb Dina.

The remaining 80% of individuals were considered diversifiers, switching from monoracial to multiracial later on, or consolidators, switching from multiracial identification to monoracial later.

Ninety-two percent of respondents repeatedly identified as monoracial; however, 2% of this group switched from one racial category to another, the study found.

In terms of rating status of health, diversifiers typically responded that their health status was “good,” “very good,” or “excellent” compared with their minority monoracial counterparts.

Tabb Dina also found while comparing access to and utilization of health care in 2008 that multiracial individuals of black-white or black-Native American ancestry were significantly less likely to utilize primary care health services.

These statistics remained even after adjusting for health insurance status.

Despite the fact that the Pew Research Center recently reported that the US population of multiracial individuals is increasing 3 times faster than the rest of the population, health care providers and researchers are slow to adapt their data-collection methods to this racial diversity.

“Even now, in 2015, medical record systems only allow patients to identify themselves using one racial category,” Tabb Dina said.

Researchers in medicine automatically recode mixed-race individuals into the least-status group, Tabb Dina explained. For example, if a patient indicates that he is black and Native American, their status is simply recorded as Native American.

“By recording race, we’re probably masking the actual health patterns that we need to uncover,” Tabb Dina said. “We’re not tapping into these patterns and not thinking creatively on how we can address racial and ethnic health disparities. Looking carefully at how people identify themselves can give us more insight into what the underlying problems are and how they differ across racial and ethnic groups.”

Developing better data collection methods to accommodate the racial diversity of individuals across the nation is important for learning how multiracial patients interact with the health care system and for addressing usage and outcome disparities.