Underestimation of cardiovascular disease mortality among Maine American Indians: the role of procedural and data errors.

We collaborated with Maine American Indian tribes to evaluate racial coding on death certificates and the effects of coding errors on estimation of cardiovascular disease (CVD) mortality. Lists of tribal decedents were matched to death certificates; 38.5% were misclassified (17.8% coding errors; 20.7% data entry errors). After errors were corrected, CVD mortality trends were similar between American Indians and all Maine residents. Racial misclassification occurred during a period when budget cuts had prompted procedural changes.