Introduction
The Latino population is the largest ethnic minority1 in the USA and is heterogeneous, especially with respect to birth country.2 Country of birth is sometimes studied as an important health and healthcare factor in Latino patients in the USA,3 4 and may be associated with differences in disease prevalence, social disadvantage, immigration status and/or acculturation.5 6 Along these lines, there have been numerous calls in the health services literature for ‘data disaggregation’ when studying minority populations,7–9 including Latinos,10 in order to better understand health and healthcare inequity. Disaggregating country of birth among Latino patients is complex, however. Rigorous and effective health services research using Latino country of birth information might have significant potential for aiding clinical and public health practice, but it depends on widespread and accurate availability of this information, co-occurring with other robust demographic and clinical data.7 11 Many commonly used sources of demographic information used in population-based research do not have robust race/ethnicity data,12–14 let alone country of birth information in Latinos,15 16 making evaluation of country of birth and its impact on healthcare impossible in many circumstances. Long-term cohort studies on Hispanic/Latino health (such as the Hispanic Community Health Study/Study of Latinos)17 18 may have country of origin data, but not detailed health system data.
Electronic health records (EHRs) are a burgeoning data source in public health and health services research in Latino populations, including in numerous Latino subpopulations19 20 and evaluations of quality of care in Latinos.20 21 To date, there are few examples of Latino country of birth reported in EHR. Community health centres (CHCs) disproportionately care for low-income Latino patients,22 and therefore, are an important setting in which to study the availability and utility of country of birth information in a clinical dataset. The OCHIN network of CHCs is one of the largest hosted linked EHR-based networks in the USA.23 Country of birth is reported in a proportion of Latino patients in the OCHIN network. Our objective was to describe the extent to which place of birth is recorded in EHRs for Latinos across a multistate network of CHCs. Furthermore, to better understand the clinical and public health utility of place-of birth information, we aimed to describe the characteristics of Latino patients with and without a recorded place of birth as well as the clinics that collect place of birth information by comparing USA)-born, non-US-born and place-of-birth not recorded Latino patients in this network.
Cardiovascular disease is the biggest cause of mortality in the USA and continues to be the main driver of mortality in Latinos. Previous studies suggest that Latino individuals experience more frequent and more poorly controlled risk factors for cardiac events,24 and evidence suggests that cardiovascular risks and care may not be uniform across Latinos of varying national origins.25 Therefore, we examined cardiovascular disease risk factors as a test case for the comparison of demographic, disease risk and care measures in US-born and non-US-born Latinos, and among Latinos where country of birth was not recorded.