Development and Validation of a Surname List to Define Chinese

Home , Ai (surname), Ang (surname), Bai (surname), Bao (surname), Bei (surname), Bi (surname)

ʈ A Hundred selected all 7 these lists are small geographic in previous studies. Surnames have the 6 1–4 The list was then enhanced developed a list of 145 Chinese developed a list of 791 Chinese 2 6 2,5–8 • Volume 44, Number 4, April 2006 METHODS and Chinese surnames reported in the assessed the agreement between self- using the Ontario vital statistics registry, 9 8 5 and proposed a revised surname list, including 7 Medical Care or earlier Chinese immigrants any secondary databases cannot be readily used to study ethnic variations in population health because of The following steps were taken toStep develop 1: the We sur- extracted Chinese surnames contained in These published lists are inconsistent in the number 2,5,7,8 RTICLE perceived Chinese ethnicity andTjam’s the list ethnicity assigned using Development of a New Chinese Surname List the lack of informationtation, on surnames ethnicity. have To beeninformation overcome used this for as limi- an defining alternative ethnicity. source of developed a Chinese surnametive list male that includedLauderdale surnames 217 and Kestenbaum distinc- andsurnames 194 using the female U.S.for surnames. Social people Security In Administration agedselected File 2000, 461 65 surnames to or formethnicity a older, subset with for and predicting a Chinese then high accuracy. from In the 2001, list, Tjam they surnames by checking the1993, Melbourne telephone Choi directory. et In al, name list: the published surname lists. M potential to accurately identifyare ancestral passed origin because onname they from lists generation haveethnicity. to been In generation. 1990, developed Hage as Chinese et al an sur- indicator of Chinese 259 surnames for defining Chinese ethnicity. and content of surnamesof as a a relatively result of smallarea inherent sample, limitations including a by adding additional surnamesChinese from Surnames the book of possible Chinese names fromtory the in Waterloo Canada telephonelogic following direc- rules, resulting Cantonese in and2004, 266 Mandarin distinctive Quan Chinese phono- surnames. et In al Thus, the comprehensivenessuncertain and when validity of thiscurrent methodology population. is Indeveloping this applied a article, to comprehensivewith we which a and Chinese ethnicity describe valid large can be work Chinese and defined in toward surname large population. list A De- ࿣ RIGINAL O to Define Chinese Ethnicity Merril L. Knudtson, MD,‡ and William A. Ghali, MD, MPH*†‡ Hude Quan, MD, PhD,*† Fulin Wang, MD, PhD,§ Donald Schopflocher, PhD,§ Development and Validation of a Surname List The Chinese surname list appears to be valid in ethnicity, Chinese, survey, population, surveillance Surnames have the potential to accurately identify an- 2006;44: 328–333) We conducted a literature review, a panel review, and a Of the 112,452 people analyzed in the Canadian Commu- Colleen Norris, PhD,¶ P. Diane Galbraith, BN,*† Peter Faris, PhD,* Michelle M. Graham, MD, Health and Policy Studies, andof the Calgary, ‡Department of Calgary, Medicine,Edmonton, University Alberta, Alberta, Canada; Canada; §Alberta andpartment of the Health Medicine, ¶Faculty and University of of Wellness, Nursing Alberta, and Edmonton, the Alberta,Calgary Canada. Health Region, Calgary,Alberta the Health Institute and of Wellness, Health Alberta,supported Economics, Canada. by Drs. and a Quan and PopulationHeritage Norris Foundation Health are for Investigator Medical Awardand Research, from by Edmonton, a Alberta, the New Canada, Alberta InvestigatorResearch. Award Dr. from the Ghali CanadianAlberta is Institutes Heritage of supported Health Foundation by forCanada, a Medical Health Research, and Scholar Edmonton, by Alberta, Services Award Research. a from the Government of Canadaences, Research University Chair of Calgary, inCanada, 3330 T2N Health Hospital 4N1. Dr. E-mail: NW, [email protected] Calgary, Alberta, Med Care 328 From the *Department of Community Health Sciences, the †Centre for The conduct of this study was supported by operating grants from the Reprints: Hude Quan, MD, PhD, Department of CommunityCopyright Health © Sci- 2006 byISSN: Lippincott 0025-7079/06/4404-0328 Williams & Wilkins Objective: cestral origins as they areIn passed this on study, we from developed generationdefine and to Chinese validated generation. ethnicity. a ChineseMethods: surname list to telephone survey in acity randomly in selected 2003 sample tovalidated from develop to a a data Canadian ChineseBoth surname from surveys list. the collected The Canadian list informationsurname. Community was on then Health self-reported Survey. ethnicityResults: and nity Health Survey, 1.6%similar were to self-reported the as 1.5% Chinese.self-reported identified Chinese This ethnicity by was (reference the standard), thehad surname surname 77.7% list list. sensitivity, Compared 80.5% positive with ificity, predictive and value, 99.6% 99.7% negative spec- predictive value.and When stratifying marital by sex status,married the women and positive 83.6%Conclusions: predictive for never value married women. wasidentifying 78.9% Chinese for ethnicity.geographic origins The and validity Chinese dialects may inKey given depend Words: populations. on the (

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U.S. Census.10 We excluded Chinese surnames that were Step 2: Five people (1 Mandarin-speaking Chinese, 1 recommended by previous studies2,5,7,8 to be excluded, be- Cantonese-speaking Chinese, 1 Korean and Mandarin-speak- cause those surnames were highly likely to misclassify non- ing Chinese, 1 Canadian-born European-origin white, and 1 Chinese individuals as being of Chinese ethnicity. Vietnamese-speaking Canadian) reviewed the list indepen-

TABLE 1. The New Chinese Surname List (1186 Surnames) AI, AN, ANG, AO, AU, AYE, BA, BAI, BAK, BAO, BAT, BAW, BEI, BEN, BI, BIAN, BIAO, BING, BIU, BO, BOK, BONG, BOU, BU, BUK, BUY, CAN, CANG, CAO, CENG, CHA, CHAI, CHAIM, CHAING, CHAK, CHANG, CHANGCHIEN, CHAT, CHAU, CHAUN, CHAUNG, CHAW, CHE, CHEAH, CHEANG, CHEAR, CHEI, CHEING, CHENCHANG, CHEO, CHEONG, CHERN, CHEUG, CHEUICHEUK, CHEUN, CHEUNJ, CHEW, CHHAY, CHHOR, CHI, CHIA, CHIAN, CHIEU, CHIEW, CHIK, CHIM, CHINN, CHIONG, CHITING, CHIUZ, CHIW, CHO, CHOCK, CHOENG, CHOH, CHONG, CHOO, CHOONG, CHOUNN, CHOUW, CHOWN, CHUA, CHUE, CHUH, CHUK, CHUN, CHUNE, CHUNG, CHUONG, CHUP, CHUY, CHYE, CHYI, CHYOU, CHYU, CHZUNG, CING, CIU, CO, COI, CONG, COU, COY, CU, CUAN, CUI, CYU, CYUN, DAI, DAN, DAU, DEA, DEE, DEFU, DEONG, DERE, DI, DIAN, DIAO, DIEC, DIEP, DIK, DIN, DING, DIU, DJANG, DJENG, DO, DOI, DONG, DOO, DOOH, DOU, DOUNG, DOW, DU, DUAN, DUANMU, DUEN, DUGU, DUNG, DUO, DUONG, EAR, ERH, FAH, FAI, FANCHIANG, FEI, FI, FING, FOCK, FOONG, FOU, FUEN, FUK, GA, GAA, GAI, GAM, GAN, GANG, GANN, GAU, GAUK, GAW, GE, GEI, GEN, GENE, GENG, GEOI, GEUNG, GIANG, GIM, GING, GIT, GIU, GO, GOENG, GOH, GON, GOO, GOOEY, GOOI, GOON, GOT, GOU, GOY, GUANG, GUEN, GUEY, GUI, GUK, GUM, GUN, GUU, GWAI, GWANG, GWIK, GWOCK, GWOK, GWON, GYUN, HA, HAHM, HAI, HAK, HAN, HANG, HAO, HAP, HAR, HAU, HECK, HEE, HEI, HENG, HEOI, HEP, HEU, HEW, HG, HIM, HIU, HO, HOI, HON, HONG, HOP, HOR, HORNG, HOTUNG, HOUNG, HSA, HSANG, HSIAD, HSIGH, HSIH, HSIUN, HSUEN, HSUNG, HUA, HUAI, HUAN, HUE, HUEN, HUIE, HUK, HUM, HUMS, HUN, HUNE, HUU, HWA, HWAI, HWANG, HWE, HWO, HWUNG, I, ING, ISANG, JAIN, JAM, JANG, JAO, JAU, JAW, JEA, JEE, JEHNG, JEI, JI, JIAO, JIE, JIEN, JIN, JIP, JOENG, JOIE, JOM, JONE, JONG, JOO, JOR, JOU, JOY, JSE, JU, JUAN, JUM, JUO, JYU, JYUN, KA, KAI, KAM, KAMKAN, KAN, KANG, KAT, KAU, KAUNG, KAWN, KE, KEE, KEET, KEH, KEI, KEN, KEOI, KEONG, KER, KEU, KEW, KHAY, KHOR, KHU, KIAO, KIEW, KIN, KIP, KIT, KLYHN, KO, KOA, KOE, KOH, KOK, KONG, KOO, KOT, KOUNG, KOWNG, KOY, KU, KUEN, KUK, KUM, KUN, KUOK, KUON, KUT, KWA, KWAIN, KWANG, KWON, KWUNG, KYOK, LA, LAM, LAN, LAO, LAU, LEM, LENG, LET, LEU, LEVNG, LEW, LIAN, LIEU, LIEW, LIK, LING, LIP, LIV, LOENG, LOH, LOI, LOK, LOR, LOUEN, LOUNG, LUAN, LUN, LUNG, LUONG, LYUN, MAI, MAK, MAN, MANG, MAO, MAT, MAU, MAW, MEI, MEN, MENG, MI, MIAN, MIAU, MIE, MIN, MING, MIU, MO, MOH, MOI, MOK, MON, MONG, MONK, MOU, MOW, MU, MUA, MUK, MUN, MUQI, NA, NAN, NANG, NANN, NAP, NAU, NEI, NENG, NEU, NEW, NGAN, NGAO, NGAU, NGAY, NGEUN, NGHEM, NGHIEM, NGIM, NGIN, NGING, NGON, NGOON, NGOR, NGOW, NGU, NGUI, NGUY, NIAN, NIE, NIN, NIPP, NOE, NOI, NOM, NUNG, NYI, OCK, OEI, OI, ON, ONG, OOI, OR, OU, OUONG, OUYOUNG, OWN, PA, PAI, PAK, PANG, PAO, PAU, PHANG, PHUA, PHUNG, PI, PIAN, PIAU, PIEN, PIH, PIN, PING, PIU, PO, POK, PONG, POO, POU, PUEN, QIANG, QIAO, QING, QUAN, QUE, QUELCH, QUEN, QUEY, QUNG, QUOORK, QWONG, RAN, REN, RONG, ROUGH, RUI, RUN, RUO, SA, SAEBAE, SAEUNG, SAH, SAI, SAM, SAN, SAT, SAU, SE, SEAH, SEC, SEEN, SEID, SEK, SEN, SENG, SEON, SEOW, SET, SHA, SHAM, SHAN, SHANGGUAN, SHAU, SHAZHA, SHEIH, SHEK, SHENH, SHEW, SHI, SHIC, SHINN, SHION, SHO, SHOON, SHOU, SHUANG, SHUE, SHUM, SI, SIAO, SIAUW, SID, SIE, SIEU, SIEW, SIKONG, SIMA, SIN, SING, SITOU, SO, SOK, SONG, SOO, SOP, SOU, SU, SUE, SUEY, SUK, SUM, SUNG, SUO, SUTU, SY, SYU, SYUN, SZETU, TA, TAN, TANG, TAT, TAY, TCHAO, TCHENG, TCHOU, TEANG, TED, TEH, TENG, TEO, TEOH, TEU, TEUNG, THEAN, THEUNG, THIAN, THOO, THOON, THUI, TIAN, TIAO, TIEN, TIEO, TIGHT, TIN, TIONG, TIP, TIU, TO, TOA, TOI, TON, TONG, TORNG, TOU, TOV, TOW, TOWE, TOY, TRI, TROUNG, TSAN, TSAUR, TSIN, TSOY, TSUANG, TSZ, TU, TUAN, TUANMU, TUEN, TUI, TUIN, TWAN, TZONG, UEN, UNG, VANG, VHANG, VONG, VOO, VUON, VUONGVY, WA, WE, WEE, WENG, WEY, WHENG, WHO, WHU, WING, WIP, WN, WNG, WOH, WON, WONE, WOO, WOON, WOU, WUE, WUENG, WUI, WY, XHOU, XIONG, XIU, XUAN, XUN, YAM, YANG, YAP, YE, YEAP, YEEN, YEL, YEOH, YEONG, YEU, YEUONG, YEW, YI, YIANG, YIE, YII, YIK, YIM, YIT, YN, YO, YOEN, YONG, YOOK, YOON, YOR, YOU, YU, YUCHI, YUCK, YUI, YUIN, YUK, YUM, YUN, YUNG, YUP, YUT, YUU, ZAI, ZAM, ZAN, ZANG, ZE, ZEE, ZEON, ZHA, ZHAD, ZHE, ZHI, ZHON, ZHUGE, ZHUONG, ZIK, ZIU, ZOENG, ZONG, ZOO, ZU, ZUK, ZUOREN, ZYU ACHANG, AUYANG, AUYEUNG, AUYONG, AUYOUNG, BAGAMAN, BIH, CAI, CEN, CHAN, CHAO, CHARNG, CHEAZ, CHEE, CHEN, CHENG, CHENNG, CHEOK, CHERNG, CHEU, CHEUCK, CHEUK, CHEUNG, CHIANG, CHIAO, CHIAU, CHIEH, CHIEN, CHIH, CHIN, CHING, CHIOU, CHIU, CHIUNG, CHOIS, CHOU, CHOW, CHOY, CHU, CHUAN, CHUANG, CHUEH, CHUEK, CHUEN, CHUENG, CHUI, CHUO, CHUU, CHWANG, CHYAN, CHYN, CI, DENG, DEP, DER, DJUNG, DOONG, ENG, EOYANG, FA, FAN, FANG, FAT, FENG, FERNG, FO, FOK, FONG, FOO, FOOK, FOON, FOT, FOUN, FOUNG, FU, FUAN, FUH, FUI, FUN, FUNG, FUT, GAO, GET, GEW, GIN, GOEY, GOK, GOM, GONG, GOONG, GU, GUAN, GUH, GUNG, GUO, GWONG, GYATSO, HAUNG, HE, HEONG, HEUNG, HING, HIP, HOM, HOO, HOU, HSE, HSEI, HSI, HSIA, HSIAN, HSIANG, HSIAO, HSICH, HSIE, HSIEH, HSIEN, HSIN, HSING, HSIU, HSIUNG, HSU, HSUAN, HSUE, HSUEH, HSUI, HSUN, HU, HUANA, HUANG, HUEI, HUENG, HUI, HUNAG, HUNG, HUO, HWEI, HWONG, HWU, IEONG, IP, ISAO, IU, JAING, JAIR, JEANG, JEN, JENG, JER, JEU, JEUNG, JEW, JHANDA, JIA, JIAN, JIANG, JIH, JIM, JING, JIU, JOW, JUANG, JUE, KAO, KEUNG, KIANG, KIU, KOU, KOW, KUAI, KUAN, KUANG, KUEI, KUEY, KUI, KUNG, KUO, KWAI, KWAN, KWEI, KWO, KWOCK, KWOH, KWOK, KWONG, LAI, LEG, LEI, LEING, LEONG, LEUNG, LI, LIANG, LIAO, LIAU, LIAW, LIEH, LIGH, LII, LIN, LIOU, LIU, LIY, LO, LOO, LOONG, LOU, LOUI, LOUIE, LU, LUEN, LUENG, LUI, LUK, LUM, LUO, MA, MAH, MAR, MIAO, MIH, MOY, MUI, NG, NGAI, NGAR, NGEE, NGEW, NGI, NGIP, NGOK, NGONG, NGOOK, NGUEY, NGUN, NI, NIEH, NING, NIP, NIU, NUEN, NUI, NUM, OONG, OUYANG, OW, OWYANG, OWYOUNG, OY, OYANG, OYOUNG, PAN, PEI, PENG, PERNG, PHOON, PON, POON, POY, PU, PUI, PUN, QI, QIAN, QIN, QIU, QU, QUING, QUN, QUOCK, QUON, QUONG, RU, RUAN, RUMJAHN, SEETO, SEETOO, SETO, SEW, SEZTO, SHANG, SHANGKUAN, SHAO, SHE, SHEE, SHEN, SHENG, SHEONG, SHEU, SHEUNG, SHIANG, SHIAO, SHIAU, SHIEH, SHIH, SHING, SHIT, SHIU, SHIUE, SHIUNG, SHU, SHUAI, SHUEH, SHUEN, SHUI, SHUN, SHUNG, SHYONG, SHYR, SHYU, SHYY, SIH, SIOU, SIT, SITU, SIU, SOOHOO, SOONG, SOW, SUEN, SUI, SUJO, SUN, SWEI, SZE, SZETO, SZTO, SZU, SZUTU, TAAM, TAI, TAM, TAO, TARNG, TAUR, TEONG, TI, TIEH, TING, TOM, TOO, TSA, TSAI, TSANG, TSAO, TSAU, TSAY, TSE, TSEN, TSENG, TSERNG, TSEU, TSEUNG, TSI, TSIA, TSIANG, TSIAO, TSIEN, TSIM, TSING, TSIU, TSO, TSOI, TSON, TSONG, TSOU, TSOW, TSU, TSUAN, TSUE, TSUEI, TSUI, TSUN, TSUNG, TUNG, TWU, TZE, TZEN, TZENG, TZO, TZOU, TZU, UANG, UENG, WAH, WAI, WAN, WANG, WAT, WAUNG, WEI, WEN, WO, WOEY, WONG, WOT, WU, WUN, WUNG, WUU, XI, XIA, XIAN, XIANG, XIAO, XIE, XIN, XING, XU, XUE, YAI, YAN, YAO, YAT, YAU, YEE, YEH, YEI, YEIN, YEN, YENG, YEP, YET, YEUNG, YICK, YIEH, YIEN, YIH, YIN, YING, YIP, YIU, YOK, YOT, YUAM, YUAN, YUANG, YUE, YUEH, YUEN, YUENG, YUET, YUEY, ZAO, ZAU, ZENG, ZHAI, ZHAN, ZHANG, ZHAO, ZHEN, ZHENG, ZHONG, ZHOU, ZHU, ZHUANG, ZHUO, ZI, ZIANG, ZOU, ZUO

Note: Surnames shown in italics are from Lauderdale’s 416 surname list.6

© 2006 Lippincott Williams & Wilkins 329 Quan et al Medical Care • Volume 44, Number 4, April 2006 dently. Reviewers were fluent in spoken and written English and ity and modified the list through an iterative process of their ethnic languages. Various ethnic reviewers were included excluding surnames with positive predictive value (PPV, the because some Chinese surnames are Romanized identically as extent to which Chinese individuals detected using the sur- Korean, Vietnamese, and European surnames in English. They name list are truly Chinese) of 50% or less and adding were instructed to identify those Chinese surnames that had the additional surnames with a PPV greater than 50%. same English spelling as non-Chinese surnames. Step 5: We added 461 surnames that were identified by Step 3: Two investigators (HQ and FW) assessed the Lauderdale and Kestenbaum6 as having a PPV of 75% or frequency of those surnames identified by the 5 reviewers by greater. Finally, we created a comprehensive surname list that crosschecking the telephone directory of the city of Edmon- contained 1186 Chinese surnames (referred to the new Chi- ton, Alberta, Canada (approximately 45,000 Chinese in the nese surname list; see Table 1. SAS code for implementing city). For surnames with high frequencies, possible Chinese the list is available at www.chaps.ucalgary.ca/sas.htm). names were determined through review of first or middle names in addition to the surname. We excluded surnames Canadian Community Health Survey from the list developed at step 1 that were 50% or less likely The Canadian Community Health Survey (CCHS; to be possibly Chinese in the telephone directory. cycle 1.1) targeted household residents aged 12 or older in Step 4: We conducted a community telephone survey in all Canadian provinces and territories and excluded popula- a multicultural city with over 55,000 Chinese Canadians to tions on Indian Reserves, Canadian Forces Bases, and some identify surnames with low sensitivity and modified the list. remote areas. A multiple-stage and complex sampling method- In the survey, data were collected through telephone ology was used to locate households in 136 health regions across surveys using a structured questionnaire. Information on the Canada. Briefly, the CCHS selected 88% of its sample from the type of telephone number, whether it is a primary or second- geographic area sampling frame and 12% from the random digit ary residential number, is flagged in the 2003 Calgary tele- dialing (RDD) frame. For each geographic area, a sample of phone directory. We randomly selected only primary phone dwellings was randomly selected. One or 2 respondents per numbers from the directory for the survey. We interviewed 1 household were selected randomly for personal interview. The respondent aged 18 or over at each telephone number and RDD sampling method used the Elimination of Non-Working excluded respondents who could not speak English, Chinese Banks technique. One respondent per household was randomly (ie, Mandarin or Cantonese, the 2 most common spoken selected and interviewed through the telephone. (See elsewhere Chinese dialects), or South Asian dialects (ie, Hindi, Urdu, for detail.12) The response rate was 84.7% (85.1% for personal Punjabi, and Gujarati). These languages were chosen because interview and 83.1% for telephone interview). Chinese and South Asian Canadians are the 2 largest visible The CCHS collected information on ethnicity by ask- minority populations in Calgary.11 ing: “To which ethnic or cultural groups did your ancestors Our survey questionnaire was developed in English. For- belong?” Under the question, a list of 18 ethnic groups ward and backward translations were performed to ensure that (including Chinese) was provided. Other demographic infor- the meanings in those translated versions were consistent. A mation such as age, sex, marital status, education, household different translator performed each translation. The question for income, country of birth, and year of immigration were ethnicity was: “People living in Canada come from many dif- collected by using the structured questionnaire. ferent cultural and racial backgrounds. Would you describe your ethnic origins as Chinese?” In the survey, each of the randomly Data Analysis selected telephone numbers was called up to 9 times at different The validity of surname-defined Chinese ethnicity was times of day and on different days of the week. measured by sensitivity (the probability of correctly identi- Of 6585 telephone numbers dialed, 5124 people were fying Chinese ethnicity with the surname list among those contacted, 3021 were surveyed, and 2808 were analyzed (54.8% who perceived themselves as Chinese), specificity (the prob- of 5124 surveyed). We examined discordant cases between ability of correctly identifying non-Chinese among those who self-reported Chinese and the surname-defined Chinese ethnic- perceived themselves as non-Chinese), and negative predic-

TABLE 2. Agreement of Chinese Ethnicity Determination Between Self-Report and Chinese Surname Lists Tested in the Canadian Community Health Survey (n ϭ 112,452) Prevalence Sensitivity Positive Predictive Speciﬁcity Negative Predictive Surname List (%) (%) Value (%) (%) Value (%) Hage et al2 1.2 56.2 75.5 99.7 99.3 Choi et al for male5 1.4 65.4 83.4 99.8 99.4 Choi et al for female5 0.9 50.2 79.9 99.8 99.3 Lauderdale et al (with 791 surnames)6 1.2 67.6 87.8 99.8 99.5 Lauderdale et al (with 461 surnames)6 0.9 52.9 91.7 99.9 99.2 Tjam7 1.8 68.9 60.8 99.3 99.5 Quan et al8 1.3 64.1 76.8 99.7 99.4 New list 1.5 77.7 80.5 99.7 99.6

330 © 2006 Lippincott Williams & Wilkins Medical Care • Volume 44, Number 4, April 2006 Surname List to Define Chinese Ethnicity tive value (NPV, the extent to which a non-Chinese person list had the highest sensitivity (77.7%) and fourth highest defined using the surname list is truly non-Chinese). Self- PPV (80.5%), which was slightly lower than Choi’s list for perceived ethnicity was used as a reference standard. males (83.4%) and Lauderdale’s lists with 791 surnames (87.8%) and 461 surnames (91.7%). Specificity and NPV RESULTS were over 99% for all of these surname lists. Of 131,535 respondents in the CCHS, 19,083 (14.5%) Table 3 shows sensitivity and PPV by sociodemograph- were excluded as a result of missing or incomplete data on ics when ethnicity was assigned using the new list and surname or ethnicity, leaving 112,452 respondents for the Lauderdale’s lists. These lists show that sensitivity and PPV final analysis. Table 2 shows that among the 8 lists, the new were low for females, people with elementary education,

TABLE 3. Agreement of Chinese Ethnicity Determination Between Self-Report and Chinese Surname Lists Tested in Canadian Community Health Survey (n ϭ 112,452) New List With Lauderdale’s List With Lauderdale’s List With 1186 Surnames 791 Surnames 461 Surnames Sensitivity Positive Predictive Sensitivity Positive Predictive Sensitivity Positive Predictive (%) Value (%) (%) Value (%) (%) Value (%) Age 12–17 74.2 81.9 64.8 88.3 50.4 93.5 18–24 80.5 87.3 71.6 91.4 56.7 93.6 25–34 78.3 80.8 66.4 89.1 53.6 91.9 35–44 78.7 81.0 68.9 87.5 51.4 90.8 45–54 77.6 81.9 64.7 87.7 51.1 90.7 55–64 72.5 67.5 64.2 76.1 53.2 84.1 65ϩ 77.8 73.9 71.3 88.2 56.3 95.0 Sex Male 81.2 81.9 71.2 89.2 56.6 93.5 Female 74.0 79.0 64.0 86.3 49.2 89.7 Education Elementary 72.4 57.8 55.2 70.6 41.4 87.8 Secondary 78.5 82.9 70.1 88.4 54.2 91.1 Postsecondary 77.9 81.7 68.0 88.5 54.4 91.7 Unknown 75.8 87.0 66.1 95.4 53.2 100.0 Marital status Single 77.8 83.5 67.4 89.7 53.6 92.9 Married 78.9 80.9 68.5 87.2 53.9 91.6 Common law 63.3 70.4 60.0 78.3 40.0 75.0 Separated 63.9 69.7 58.3 84.0 52.8 86.4 Divorced 66.7 59.5 60.6 83.3 33.3 84.6 Widowed 77.4 66.1 69.8 82.2 49.1 92.9 Unknown 100.0 66.7 75.0 100.0 25.0 100.0 Income Ͻ$30,000 80.1 78.4 71.0 87.2 53.5 91.6 $30,000–49,999 82.9 82.2 74.5 89.9 56.5 91.5 $50,000–79,999 73.3 78.7 61.3 87.6 49.6 93.8 $80,000ϩ 70.2 79.6 58.7 88.0 47.8 94.3 Unknown 80.2 82.5 70.8 86.9 55.7 89.5 Speaking English or French Yes 76.3 78.9 66.0 86.7 51.6 90.7 No 84.8 89.5 75.9 93.2 60.0 96.7 Length of stay in Canada (years) Յ5 88.3 88.8 81.7 92.3 65.5 94.1 6–10 85.9 93.4 79.8 95.2 64.8 95.7 11–15 82.9 91.9 69.7 94.2 52.6 97.6 16–20 81.6 88.7 70.4 91.7 43.2 91.5 Ͼ20 73.3 83.2 58.5 86.9 45.2 95.2 Born in Canada 60.8 55.7 51.1 71.3 42.2 78.7

© 2006 Lippincott Williams & Wilkins 331 Quan et al Medical Care • Volume 44, Number 4, April 2006 certain categories of marital status (common law, separated, very close to the self-reported proportion (1.6%) and higher or divorced), higher income, English- or French-speaking, than the proportions estimated by Lauderdale’s lists (1.2% for early immigrants, or people born in Canada. the list with 791 surnames and 0.9% for the list with 461 To examine impact of marital status on agreement, we surnames). The estimated proportion of Chinese was similar stratiﬁed the analysis by gender and marital status. Compared between the new list and self-reported Chinese across all with never married females, married females demonstrated sociodemographic strata. lower sensitivity (73.2% vs. 76.7%) and positive predictive value (78.9% vs. 83.6%) for the new list. DISCUSSION Table 4 shows that the proportion of the population We have generated a new Chinese surname list through estimated to be Chinese according to the new list (1.5%) is literature review, a panel review, and a community survey in

TABLE 4. Proportion of Chinese as Determined by Self-Report and Three Different Chinese Surname Lists Applied to the Canadian Community Health Survey (n ϭ 112,452) New List With Lauderdale’s List With Lauderdale’s List With Self-Report 1186 Surnames 791 Surnames 461 Surnames Characteristics n (%) n (%) n (%) n (%) Overall 1800 (1.6) 1736 (1.5) 1386 (1.2) 1039 (0.9) Sex Male 915 (1.8) 907 (1.7) 730 (1.4) 554 (1.1) Female 885 (1.5) 829 (1.4) 656 (1.1) 485 (0.8) Age 12–17 256 (2.2) 232 (2.0) 188 (1.7) 138 (1.2) 18–24 282 (2.7) 260 (2.5) 221 (2.1) 171 (1.6) 25–34 295 (1.8) 286 (1.7) 220 (1.3) 172 (1.1) 35–44 405 (1.9) 394 (1.8) 319 (1.5) 229 (1.1) 45–54 286 (1.6) 271 (1.5) 211 (1.2) 161 (0.9) 55–64 109 (0.8) 117 (0.9) 92 (0.7) 69 (0.5) 65ϩ 167 (0.8) 176 (0.9) 135 (0.7) 99 (0.5) Education Elementary 87 (0.5) 109 (0.6) 68 (0.4) 41 (0.2) Secondary 284 (1.8) 269 (1.7) 225 (1.4) 169 (1.1) Postsecondary 1367 (1.8) 1304 (1.7) 1050 (1.4) 796 (1.1) Unknown 62 (3.0) 54 (2.7) 43 (2.1) 33 (1.6) Marital status Single 737 (2.2) 686 (2.1) 554 (1.7) 425 (1.3) Married 907 (1.8) 885 (1.8) 712 (1.4) 534 (1.1) Common law 30 (0.4) 27 (0.3) 23 (0.3) 16 (0.2) Separated 36 (1.0) 33 (0.9) 25 (0.7) 22 (0.6) Divorced 33 (0.5) 37 (0.5) 24 (0.3) 13 (0.2) Widowed 53 (0.5) 62 (0.6) 45 (0.4) 28 (0.3) Unknown 4 (6.3) 6 (9.4) 3 (4.7) 1 (1.6) Income Ͻ$30,000 327 (1.2) 334 (1.2) 266 (1.0) 191 (0.7) $30,000–49,999 322 (1.5) 325 (1.6) 267 (1.3) 199 (1.0) $50,000–79,999 333 (1.4) 310 (1.3) 233 (1.0) 176 (0.8) $80,000ϩ 312 (1.7) 275 (1.5) 208 (1.1) 158 (0.9) Unknown 506 (2.3) 492 (2.2) 412 (1.8) 315 (1.4) Speaking English or French Yes 1510 (1.4) 1461 (1.3) 1150 (1.0) 859 (0.8) No 290 (18.1) 275 (17.2) 236 (14.7) 180 (11.2) Length of stay in Canada (years) Յ5 359 (18.7) 341 (18.5) 300 (16.3) 236 (12.8) 6–10 350 (22.5) 319 (21.1) 291 (19.3) 235 (15.5) 11–15 218 (15.2) 211 (14.0) 173 (11.4) 126 (8.3) 16–20 131 (14.8) 115 (13.5) 96 (11.2) 59 (6.9) Ͼ20 339 (4.0) 310 (3.6) 237 (2.8) 167 (2.0) Born in Canada 374 (0.4) 440 (0.5) 289 (0.3) 216 (0.2)

332 © 2006 Lippincott Williams & Wilkins Medical Care • Volume 44, Number 4, April 2006 Surname List to Define Chinese Ethnicity a Canadian city. This new Chinese surname list had a sensi- (55%) has the potential to introduce nonresponse bias into our tivity of 78%, a PPV of 81%, and specificity and NPV over study. However, any such bias is likely to be minor in our 99% in external test data from a Canadian national commu- internal validation assessment because the proportion of self- nity survey. This external testing reveals the new list to be reported Chinese (5.4%) was similar to the 5.5% prevalence more sensitive for defining Chinese ethnicity than are previ- of the Chinese population in Calgary as reported by the 2001 ously published Chinese surname lists. Canadian census.11 The lower proportion of Chinese in the The validity of Chinese surname lists in identifying CCHS (1.6%) relative to the census (3.5%), meanwhile, is Chinese ethnicity is related to the fact that English letter likely to cause some underestimation of the PPV. combinations for many Chinese surnames are unique. Chi- In conclusion, the Chinese surname list developed here nese surnames are commonly composed of 1 short word or appears to be a valid method to identify individuals of syllable such as “Wang,” and over 90% of Chinese people Chinese ethnicity. The validity may depend on the geo- use 100 or so common surnames although there are hundreds graphic origin and Chinese dialects in given populations. of distinctive surnames.9 However, misclassification of Chinese ethnicity cannot be The different methods of Romanizing Chinese sur- avoided in certain instances because the surname list contains names and the occurrence of a surname change after marriage some Chinese surnames that overlap with Asian and white are major reasons for misclassification of Chinese ethnicity surnames and also because the list misses rare Chinese when surname lists are used to define ethnicity in Western surnames. countries. Romanization results in some identical non-Chi- nese and Chinese surnames. For example, the surname “Lee” could be European, Korean, or Chinese. Traditionally, Chi- REFERENCES nese women always retain their family names even after 1. Au WY, Gascoyne RD, Gallagher RE, et al. 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