National data on mortality are more accurate for blacks and whites than for Hispanics, Asians and Native Americans. A major problem affecting the quality of mortality data is related to the undercount in the number of deaths because of the misclassification of non-trivial proportions of Hispanics, Asians, and especially American Indians as white on death certificates.10 This error leads to an undercount in the numerator for death rates for these groups that underestimates their actual death rates. Challenges of population coverage and/or inadequate sample size for small racial populations and ethnic subgroups within the larger racial categories continue to obscure population patterns of health risks. For example, aggregation of the Native Hawaiian and other Pacific Islander (NHOPI) group with the Asian category obscures the reality that the NHOPIs are one of the highest risk populations in the U.S. in terms of CVD, diabetes, and obesity risk.11 Similarly, Arab Americans are masked under the white population of the U.S. and although they have relatively high levels of SES, they have elevated risk of some diseases such as diabetes and certain cancers.12
