Determinants of Racial Misclassification in COVID-19 Mortality Data: The Role of Funeral Directors and Social Context

Abstract

Death certificates are a crucial tool in public health, yet American Indians and Alaska Natives have long been misclassified after death, most often as white. During the COVID-19 pandemic, rapid provisional death counts have used data from death certificates to identify outbreaks and allocate resources. This paper interrogates common practices of funeral directors—who complete the demographic portion of the death certificate—as well as the social context in which they operate. The paper then reviews how these determinants of American Indian and Alaska Native misclassification may have changed during the pandemic and discusses implications for the quality of COVID-19 mortality data and opportunities for improvement.