Quality of ethnicity data within Scottish health records and implications of misclassification for ethnic inequalities in severe COVID-19: a national linked data study

Sarah Amele, Ronan McCabe, Eliud Kibuchi, Anna Pearce, Kirsten Hainey, Evangelia Demou, Patricia Irizar, Dharmi Kapadia, Harry Taylor, James Nazroo, Laia Bécares, Duncan Buchanan, Paul Henery, Sandra Jayacodi, Lana Woolford, Colin R Simpson, Aziz Sheikh, Karen Jeffrey, Ting Shi, Luke DainesHolly Tibble, Fatima Almaghrabi, Adeniyi Francis Fagbamigbe, Amanj Kurdi, Chris Robertson, Serena Pattaro, Srinivasa Vittal Katikireddi

Research output: Contribution to journalArticlepeer-review


BACKGROUND: We compared the quality of ethnicity coding within the Public Health Scotland Ethnicity Look-up (PHS-EL) dataset, and other National Health Service datasets, with the 2011 Scottish Census.

METHODS: Measures of quality included the level of missingness and misclassification. We examined the impact of misclassification using Cox proportional hazards to compare the risk of severe coronavirus disease (COVID-19) (hospitalization & death) by ethnic group.

RESULTS: Misclassification within PHS-EL was higher for all minority ethnic groups [12.5 to 69.1%] compared with the White Scottish majority [5.1%] and highest in the White Gypsy/Traveller group [69.1%]. Missingness in PHS-EL was highest among the White Other British group [39%] and lowest among the Pakistani group [17%]. PHS-EL data often underestimated severe COVID-19 risk compared with Census data. e.g. in the White Gypsy/Traveller group the Hazard Ratio (HR) was 1.68 [95% Confidence Intervals (CI): 1.03, 2.74] compared with the White Scottish majority using Census ethnicity data and 0.73 [95% CI: 0.10, 5.15] using PHS-EL data; and HR was 2.03 [95% CI: 1.20, 3.44] in the Census for the Bangladeshi group versus 1.45 [95% CI: 0.75, 2.78] in PHS-EL.

CONCLUSIONS: Poor quality ethnicity coding in health records can bias estimates, thereby threatening monitoring and understanding ethnic inequalities in health.

Original languageEnglish
Pages (from-to)116-122
Number of pages7
JournalJournal of public health
Issue number1
Publication statusPublished - 23 Feb 2024


  • Humans
  • Ethnicity
  • State Medicine
  • Semantic Web
  • COVID-19
  • Scotland/epidemiology

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