dc.description.abstract |
Background: Race and ethnicity classification systems have considerable implications for public health, including
the potential to reveal or mask inequities. Given increasing “super-diversity” and multiple racial/ethnic identities in
many global settings, especially among younger generations, different ethnicity classification systems can
underrepresent population heterogeneity and can misallocate and render invisible Indigenous people and ethnic
minorities. We investigated three ethnicity classification methods and their relationship to sample size, sociodemographics
and sexual health indicators.
Methods: We examined data from New Zealand’s HIV behavioural surveillance programme for men who have sex
with men (MSM) in 2006, 2008, 2011, and 2014. Participation was voluntary, anonymous and self-completed;
recruitment was via community venues and online. Ethnicity allowed for multiple responses; we investigated three
methods of dealing with these: Prioritisation, Single/Combination, and Total Response. Major ethnic groups included
Asian, European, indigenous Māori, and Pacific. For each classification method, statistically significant associations
with ethnicity for demographic and eight sexual health indicators were assessed using multivariable logistic
regression.
Results: Overall, 10,525 MSM provided ethnicity data. Classification methods produced different sample sizes, and
there were ethnic disparities for every sexual health indicator. In multivariable analysis, when compared with
European MSM, ethnic differences were inconsistent across classification systems for two of the eight sexual health
outcomes: Māori MSM were less likely to report regular partner condomless anal intercourse using Prioritisation or
Total Response but not Single/Combination, and Pacific MSM were more likely to report an STI diagnosis when using
Total Response but not Prioritisation or Single/Combination.Conclusions: Different classification approaches alter sample sizes and identification of health inequities. Future
research should strive for equal explanatory power of Indigenous and ethnic minority groups and examine
additional measures such as socially-assigned ethnicity and experiences of discrimination and racism. These findings
have broad implications for surveillance and research that is used to inform public health responses.
Keywords: Ethnicity classification, Public health, Surveillance, Sexual health, Health equity, Race, Racism, Surveys,
Men who have sex with men (MSM), New Zealand |
en |