Looking for a SNOMED-CT code for Jewish ethnicity

CIHI has published proposed standards for race-based and Indigenous identity data (see here: www.cihi.ca/en/proposed-standards-for-race-based-and-indigenous-identity-data). We have not published any standards for ethnicity (i.e. ethnic group or ethnic origin) nor ethnicity-related concepts (e.g., language, immigrant status, religion); however, we do provide a conceptual definition of ethnicity and the rationale for using ethnicity-related data in the document.

The race-based standards are to measure and monitor inequalities that may stem from racism, discrimination and bias. Based on external consultations and our review, we do not support the use of “race” or ethnicity as proxy measures for genetics. Race-based data should be used to help identify inequalities stemming from racism, and ethnicity-related concepts (e.g., religion, immigration status, language, etc.) can be used to identify inequalities stemming from specific cultural factors, to inform service planning/tailoring care, and to help understand patient diversity. To this end, using Jewish (religion) may be appropriate for identifying potential inequalities rooted in bias or discrimination (although race-based data may be more practical), as well as the potential need to accommodate for certain religious practices in the provision of care.

The intended use of the data should guide the identification of appropriate variables. If you are interested in understanding racism, consider using the proposed race-based data standards; if you’re interested in language barriers, use an appropriate language variable; if you’re interested in identifying religious/spiritual groups using health care services, consider using a measure of religious affiliation, for example. Using conflated measures of ethnicity is generally problematic because it becomes unclear if people are reporting their ancestry, religion, language, nationality, etc., there are often different levels of granularity provided, and it becomes increasingly difficult to make fair comparisons. If you want to understand granularity within groups, consider intersectional analysis using different concepts (e.g., race, religion, language, etc.).

To address the original question, our recommendation would depend on the intended use of the data. We recognize the nuances between “Jewish” as an ethnic group versus Judaism as a religion, especially knowing that many who do not practice may still identify as Jewish. Generally, however, data of that level of granularity is difficult to action in the health system. If the purpose is to measure patient diversity, it may make sense to request a code for Jewish ethnicity. While you could do the same for identifying populations at risk for certain conditions, we do not recommend the use of ethnicity data for this purpose. If the purpose is to tailor care, it may suffice to use the Jewish religion code.

Because this is a very sensitive area, SNOMED International is no longer adding ethnicity and racial concepts in the international terminology. It is left to each country to determine what content they accept in their Edition and to ensure the content is Unambiguous, Reproducible and Understandable. We are aware there is a mixture of religious and/or ethnic and/or racial concepts in the SNOMED CT terminology that may be used and the selection of a concept may be different based on the use cases. The work started by CIHI on the ethnicity, should help in better defining the ethnicity/race concepts and facilitate data standardisation and data capture in Canada.

In the meantime, Infoway is accepting requests for change that meet Canadian specific use cases. In the last years, Infoway has created ethnicity and race concepts in the Canadian Edition to meet stakeholders requirements for data capture. You can find those codes here .

If you need a new concept that is not in the terminology, you may consider submitting a request for the addition of such a concept with the appropriate reference material and use case. Please find all information for submission of a request on this page: infocentral.infoway-inforoute.ca/en/tools/collaboration-tools/informs

I suggest, author a local code (with registered namespace ID) and submit it to NRC (Canada Health Infoway) to be included in the next SNOMED CT Canadian release edition. Please let me know if you need further information.

Regards,
Harsh Sharma

This is indeed very complicated question. Technically, there is no overarching Jewish ethnicity as Jewish people consist of multiple distinct ethnicities: Ashkenazim (European Jews), Sephardim (Spanish/Iberian Jews), Ethiopian Jews, Karaite Jews, many Mizrahim (Oriental Jews) ethnic subdivisions.

These different ethnic groups have historically been identified by Judaism as they had shared the same religion and used the same Biblical Hebrew language along with a local spoken language (e.g. Yiddish, Ladino, etc.). However, in the last century, since the rise of secularism, Jews can probably be considered as a "self-identifying ethnicity" based on the common culture.

I haven't seen a Jewish self-identifying ethnicity been defined in any terminology yet, but this might be a good idea to request the major SDOs to create a new concept.

Not to discourage anyone from using SNOMED, but I would not recommend using the terminology for recording race/ethnicity in an EHR. One of the main issues here is jurisdictional variation so it's difficult for SI to maintain universally accepted content in this area.

Race and ethnicity is often defined by a country's census bureau. (i.e Stats Canada.) When an EHR uses a race or ethnicity code from its local jurisdiction, then at least there is a way to trace what it means in that context.

Great question! So complex. There is no clear answer. CIHI is leading the work on ethnicity, so I'll ask that Alana weighs in as well. The dominant perspective in the terminology seems be that Judaism is a religion, rather than an ethnicity. Like, is Catholicism a culture? Yes and no. Religions govern cultural norms, practices and beliefs to a certain degree and so might also be considered ethnicity by some. The argument is certainly a valid one. But from the perspective of coding patient information in EHRs, there are at least two options for you to consider: first, you can selected from the many terms related to Judaism, like 276121002 |Judaism (religion/philosophy)|, knowing that this may not be too general a concept to describe some people (eg. 298043007 |Liberal Jewish religion (religion/philosophy)|); second, you can select a concept that reflects how a person might describe themselves or be described by others (but not within the ethnicity subhierarchy) (eg. 160543007 |Jewish, follower of religion (person)|; or third, you may consider submitting a request for the addition of an ethnicity concept with the appropriate reference material.

My guess is that a clear use case for the term you are seeking will help, as well.