Blood Politics, Ethnic Identity, and Racial Misclassification among American Indians and Alaska Natives

Table 1

Reasons for racial misclassification in American Indian/Alaska Native data*.

Systems level	Policy level	Individual level
(i) No electronic medical record available; (ii) Unable to link to other registries; (iii) No patient query or lack of race/ethnicity field in data collection; (iv) Inadequate definitions of AI/AN identity	(i) Spanish surnames—automatically classified as Hispanic; (ii) Physical appearance of individual; (iii) Age; (iv) Decreasing blood quantum	(i) Refusal to answer; (ii) Not able to identify with a particular ethnic or racial identity; (iii) Forced to identify one race in forms, so the patient picks the one closest to day to day activities; (iv) Previous generation did not enroll

∗At the time of this writing, there are additional issues regarding some tribes changing enrollment requirements for tribal members. This issue is broad and complex and beyond the scope of this paper.