Alternate Name	Item#	Length	Source of Standard	Column #
	254	3	NAACCR	444-446

Description
Code for the country in which the patient was born. If the patient has multiple tumors, all records should contain the same code. This data item became part of the NAACCR transmission record effective with Volume II, Version 13 in order to include country and state for each geographic item and to use interoperable codes. It supplements the item BIRTHPLACE--STATE [252]. These two data items are intended to replace the use of BIRTHPLACE [250].

Rationale
Place of Birth is helpful for patient matching and can be used when reviewing race and ethnicity. It is an important item in algorithms for imputing race and ethnicity. In addition, adding birthplace data to race and ethnicity allows for a more specific definition of the population being reported. Careful descriptions of ancestry, birthplace, and immigration history of populations studied are needed to make the basis for classification into ethnic groups clear. Birthplace has been associated with variation in genetic, socioeconomic, cultural, and nutritional characteristics that affect patterns of disease. A better understanding of the differences within racial and ethnic categories also can help states develop effective, culturally-sensitive public health prevention programs to decrease the prevalence of high-risk behaviors and increase the use of preventive services.

Codes

See Appendix B for numeric and alphabetic lists of places and codes (also see Appendix B of the SEER Program Code Manual at seer.cancer.gov/tools/codingmanuals/index.html).

Custom codes for both historic and future use
ZZN	North America NOS
ZZC	Central American NOS
ZZS	South America NOS
ZZP	Pacific NOS
ZZE	Europe NOS
ZZF	Africa NOS
ZZA	Asia NOS
ZZX	Non-US NOS
ZZU	Unknown
Custom codes for historic use only
XNI	North American Islands
XCB	Other Caribbean Islands
XEN	England, Channel Islands, Isle of Man
XSC	Scandinavia
XGR	Germanic Countries
XSL	Slavic Countries
XCZ	Czechoslovakia (former)
XYG	Yugoslavia (former)
XUM	Ukraine and Moldova
XNF	North Africa
XSD	Sudanese Countries
XWF	West Africa
XSF	South Africa
XEF	East Africa
XIF	African Islands
XET	Ethiopia and Eritrea
XAP	Arabian Peninsula
XIS	Israel and Palestine
XCR	Caucasian Republics of former USSR
XOR	Other Asian Republics of former USSR
XSE	Southeast Asia
XMS	Malaysia, Singapore, Brunei
XCH	China, NOS
XML	Melanesian Islands
XMC	Micronesian Islands
XPL	Polynesian Islands