Racial and Socioeconomic Disparities in Bone Density Testing Before and After Hip Fracture
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Racial and socioeconomic disparities have been identified in osteoporosis screening.
To determine whether racial and socioeconomic disparities in osteoporosis screening diminish after hip fracture.
Retrospective cohort study of female Medicare patients.
Entire states of Illinois, New York, and Florida.
Female Medicare recipients aged 65–89 years old with hip fractures between January 2001 and June 2003.
Differences in bone density testing by race/ethnicity and zip-code level socioeconomic characteristics during the 2-year period preceding and the 6-month period following a hip fracture.
Among all 35,681 women with hip fractures, 20.7% underwent bone mineral density testing in the 2 years prior to fracture and another 6.2% underwent testing in the 6 months after fracture. In a logistic regression model adjusted for age, state, and comorbidity, women of black race were about half as likely (RR 0.52 [0.43, 0.62]) and Hispanic women about 2/3 as likely (RR 0.66 [0.54, 0.80]) as white women to undergo testing before their fracture. They remained less likely (RR 0.66 [0.50, 0.88] and 0.58 [0.39, 0.87], respectively) to undergo testing after fracture. In contrast, women residing in zip codes in the lowest tertile of income and education were less likely than those in higher-income and educational tertiles to undergo testing before fracture, but were no less likely to undergo testing in the 6 months after fracture.
Racial, but not socioeconomic, differences in osteoporosis evaluation continued to occur even after Medicare patients had demonstrated their propensity to fracture. Future interventions may need to target racial/ethnic and socioeconomic disparities differently.
- Neuner, JM, Binkley, N, Sparapani, RA, Laud, PW, Nattinger, AB (2006) Bone density testing in older women and its association with patient age. J Am Geriatr Soc 54: pp. 485-489 CrossRef
- Solomon, DH, Brookhart, MA, Gandhi, TK (2004) Adherence with osteoporosis practice guidelines: a multilevel analysis of patient, physician, and practice setting characteristics. Am J Med 117: pp. 919-924 CrossRef
- Miller, RG, Ashar, BH, Cohen, J (2005) Disparities in osteoporosis screening between at-risk African-American and white women. J Gen Intern Med 20: pp. 847-851 CrossRef
- Smedley, BD, Stith, AY, Nelson, AR (2002) Unequal Treatment: Confronting Racial and Ethnic Disparities in Healthcare. The National Academies Press, Washington, DC
- Cauley, JA, Lui, L-Y, Ensrud, KE (2005) Bone mineral density and the risk of incident nonspinal fractures in black and white women. JAMA 293: pp. 2102-2108 CrossRef
- Barrett-Connor, E, Siris, ES, Wehren, LE (2005) Osteoporosis and fracture risk in women of different ethnic groups. J Bone Miner Res 20: pp. 85-94 CrossRef
- Cummings, SR, Black, DM, Thompson, DE (1998) Effect of alendronate on risk of fracture in women with low bone density but without vertebral fractures: results from the Fracture Intervention Trial. JAMA 280: pp. 2077-2082 CrossRef
- Harris, S, Watts, N, Genant, H (1999) Effects of risedronate treatment on vertebral and nonvertebral fractures in women with postmenopausal osteoporosis: a randomized controlled trial. JAMA 282: pp. 1344-1352 CrossRef
- Liberman, UA, Weiss, SR, Broll, J (1995) Effect of oral alendronate on bone mineral density and the incidence of fractures in postmenopausal osteoporosis. The Alendronate Phase III Osteoporosis Treatment Study Group. N Engl J Med 333: pp. 1437-1443 CrossRef
- Colon-Emeric, C, Kuchibhatla, M, Pieper, C (2003) The contribution of hip fracture to risk of subsequent fractures: data from two longitudinal studies. Osteoporos Int 14: pp. 879 CrossRef
- Bone Health and Osteoporosis: A Report of the Surgeon General. U.S. Department of Health and Human Services, Office of the Surgeon General, Rockville, MD
- Hodgson, SF, Watts, NB, Bilezikian, JP (2001) American Association of Clinical Endocrinologists 2001 medical guidelines for clinical practice for the prevention and management of postmenopausal osteoporosis. Endocr Pract 7: pp. 293-312
- Physicians’ Guide to Prevention and Treatment of Osteoporosis. National Osteoporosis Foundation, Washington, DC
- NIH. Osteoporosis Prevention, Diagnosis, and Therapy. NIH Consensus Statement Online March 27–29 2000. (Accessed 2006 November 21); 17(1):1–36.
- Center for Medicare and Medicaid Services. Data User’s Reference Guide. 2000. Available at http://www.resdac.umn.edu/Medicare/data_file_descriptions.asp#rif. (Accessed 2007 June 2).
- Ray, WA, Griffin, MR, Fought, RL, Adams, ML (1992) Identification of fractures from computerized Medicare files. J Clin Epidemiol 45: pp. 703-714 CrossRef
- U.S. Department of Health and Human Services. Health Technology Assessment. Number 6: Bone Densitometry: Patients with Asymtomatic Hyperparathyroidism. AHRQ Publication No. 96-0004. Rockville, MD: Agency for Health Care Policy and Research, U.S. Department of Health and Human Services; 1995.
- Bates, DW, Black, DM, Cummings, SR (2002) Clinical use of bone densitometry: clinical applications. JAMA 288: pp. 1898-1900 CrossRef
- Solomon, DH, Finkelstein, JS, Katz, JN, Mogun, H, Avorn, J (2003) Underuse of osteoporosis medications in elderly patients with fractures. Am J Med 115: pp. 398-400 CrossRef
- Krieger, N (1992) Overcoming the absence of socioeconomic data in medical records: validation and application of a census-based methodology. Am J Public Health 82: pp. 703-710
- Geronimus, AT, Bound, J (1998) Use of census-based aggregate variables to proxy for socioeconomic group: evidence from national samples. Am J Epidemiol 148: pp. 475-486
- Charlson, M, Pompei, P, Ales, K, MacKenzie, C (1987) A new method of classifying prognostic comorbidity in longitudinal studies. J Chronic Dis 40: pp. 373-383 CrossRef
- Deyo, RA, Cherkin, DC, Ciol, MA (1992) Adapting a clinical comorbidity index for use with ICD-9-CM administrative databases. J Clin Epidemiol 45: pp. 613-619 CrossRef
- Klabunde, CN, Potosky, AL, Legler, JM, Warren, JL (2000) Development of a comorbidity index using physician claims data. J Clin Epidemiol 53: pp. 1258-1267 CrossRef
- Zhang, J, Yu, KF (1998) What’s the relative risk? A method of correcting the odds ratio in cohort studies of common outcomes. JAMA 280: pp. 1690-1691 CrossRef
- Mudano, AS, Casebeer, L, Patino, F (2003) Racial disparities in osteoporosis prevention in a managed care population. South Med J 96: pp. 445-451 CrossRef
- Wilkins, CH, Goldfeder, JS (2004) Osteoporosis screening is unjustifiably low in older African-American women. J Natl Med Assoc 96: pp. 461-467
- Jacobsen, SJ, Goldberg, J, Miles, TP, Brody, JA, Stiers, W, Rimm, A (1992) Race and sex differences in mortality following fracture of the hip. Am J Public Health 82: pp. 1147-1150 CrossRef
- Furstenberg, A, Mezey, M (1987) Differences in outcome between black and white elderly hip fracture patients. J Chronic Dis 40: pp. 931-938 CrossRef
- Burgess, DJ, Fu, SS, Ryn, M (2004) Why do providers contribute to disparities and what can be done about it?. J Gen Intern Med 19: pp. 1154-1159 CrossRef
- Balsa, AI, McGuire, TG (2003) Prejudice, clinical uncertainty and stereotyping as sources of health disparities. J Health Econ 22: pp. 89-116 CrossRef
- Pathman, D, Fowler-Brown, A, Corbie-Smith, G (2006) Differences in access to outpatient medical care for black and white adults in the Rural South. Med Care 44: pp. 429-438 CrossRef
- Hip Fracture Outcomes in People Age 50 and Over—Background Paper. OTA-BP-H-120. U.S. Government Printing Office, Washington, DC
- Grisso, JA, Kelsey, JL, Strom, BL (1994) Risk factors for hip fracture in black women. N Engl J Med 330: pp. 1555-1559 CrossRef
- Barrett-Connor, E, Siris, ES, Wehren, LE (2005) Osteoporosis and fracture risk in women of different ethnic groups. J Bone Miner Res 20: pp. 185-194 CrossRef
- Braveman, PA, Cubbin, C, Egerter, S (2005) Socioeconomic status in health research: one size does not fit all. JAMA 294: pp. 2879-2888 CrossRef
- Lurie, N (2005) Health disparities—less talk, more action. N Engl J Med 353: pp. 727-729 CrossRef
- Campbell, H, Hotchkiss, R, Bradshaw, N, Porteous, M (1998) Integrated care pathways. BMJ 316: pp. 133-137
- Harrington, JT, Barash, HL, Day, S, Lease, J (2005) Redesigning the care of fragility fracture patients to improve osteoporosis management: a health care improvement project. Arthritis Rheum 53: pp. 198-204 CrossRef
- Racial and Socioeconomic Disparities in Bone Density Testing Before and After Hip Fracture
Journal of General Internal Medicine
Volume 22, Issue 9 , pp 1239-1245
- Cover Date
- Print ISSN
- Online ISSN
- Additional Links
- osteoporosis screening
- hip fracture
- Industry Sectors
- Author Affiliations
- 1. Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
- 2. Center for Patient Care and Outcomes Research and Division of Biostatistics, Health Policy Institute, Medical College of Wisconsin, 8701 Watertown Plank Rd., Suite H2755, Milwaukee, WI, 53226, USA
- 3. Department of Mathematics and Statistics, Georgia State University, Atlanta, GA, USA