The importance of including aliases in data linkage with vulnerable populations

BACKGROUND: Records pertaining to individuals whose identity cannot be verified with legal documentation may contain errors, or be incorrect by intention of the individual. Probabilistic data linkage, especially in vulnerable populations where the incidence of such records may be higher, must be considerate of the usage of these records. METHODS: A data linkage was conducted between Queensland Youth Justice records and the Australian National Death Index. Links were assessed to determine how often they were made using the unverified (alias) records that would not have been made in their absence (i.e. links that were not also made using solely verified records). Anomalies in the linked records were investigated in order to make evaluations of the sensitivity and specificity of the linkage, compared to the links made using only verified records. RESULTS: From links made using verified records only, 1309 deaths were identified (2.6% of individuals). Using alias records in addition, the number of links increased by 16%. Links made using alias records only were more common in females, and those born after 1985. Different records belonging to the same individual in the justice dataset did not link to different death records, however there were instances of the same death record linking to multiple cohort individuals. CONCLUSIONS: The inclusion of aliases in data linkage in youths involved in the justice system increased mortality ascertainment without any discernible increase in false positive matches. We therefore conclude that alias records should be included in data linkage procedures in order to avoid biased attenuation of ascertainment in vulnerable populations, leading to the concealment of health inequality.