Abstract
Although a number of studies have examined racial variation in antiresorptive medication use, those studies are limited to generalizing beyond the use of hormone therapy (HT), geographic region, and black ethnicity. Our primary aims were (1) to describe variation in the use of antiresorptive medications among US women of different ethnicities aged 45 years and older in the year 2000 and (2) to understand the association between ethnicity and antiresorptive medication use after adjustment for other factors that might have had an impact on use. The data source used in this study was the 2000 Medical Expenditure Panel Survey. Using a modified health services utilization model we performed hierarchical multivariate logistic regression analyses to examine the relationship between race and antiresorptive medication use. The use of HT among blacks, Hispanics, and other ethnicities was significantly less than among whites. This relationship was significant, even after we had controlled for predisposing, enabling, and need characteristics. The use of newer antiresorptive medications (bisphosphonates, raloxifene, and nasal calcitonin) also was less common among racial minorities than among whites. However, controlling for predisposing characteristics of education, income, census region, and age eliminated differences in use between Hispanics and whites. Controlling for need characteristics of health status, osteoporosis, and predisposing illnesses eliminated differences in antiresorptive use between blacks and whites. Significant differences in the use of newer antiresorptives remained between other ethnicities and whites, even in the fully specified model. The results of this study suggest that ethnicity is a significant predictor of the use of both HT and newer antiresorptive medication. These results also suggest that a number of variables are important in explaining racial differences in antiresorptive use, particularly among users of newer antiresorptive medications.
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References
Institute of Medicine (2002) Unequal treatment: confronting racial and ethnic disparities in health care. National Academy Press, Washington, DC
Potosky AL, Harlan LC, Kaplan RS, Johnson KA, Lynch CF (2002) Age, sex, and racial differences in the use of standard adjuvant therapy for colorectal cancer. J Clin Oncol 20:1192–1202
Randall TC, Armstrong K (2003) Differences in treatment and outcome between African–American and white women with endometrial cancer. J Clin Oncol 21:4200–4206
Chen J, Rathore SS, Radford MJ, Wang Y, Krumholz HM (2001) Racial differences in the use of cardiac catheterization after acute myocardial infarction. N Engl J Med 344:1443–1449
Sclar DA, Robison LM, Skaer TL, Dickson WM, Kozma CM, Reeder CE (1998) Antidepressant prescribing patterns. Clin Drug Invest 16:135–140
Copeland LA, Zeber JE, Valenstein M, Blow FC (2003) Racial disparity in the use of atypical antipsychotic medications among veterans. Am J Psychiatry 160:1817–1822
Kuno E, Rothbard AB (2002) Racial disparities in antipsychotic prescription patterns for patients with schizophrenia. Am J Psychiatry 159:567–572
Bartman BA, Moy E (1998) Racial differences in estrogen use among middle-aged and older women. Women Health 8:32–44
Brown AF, Perez-Stable EJ, Whitaker EE, Posner SF, Alexander M, Gathe J, Washington AE (1999) Ethnic differences in hormone replacement prescribing patterns. J Gen Intern Med 14:663–669
Mudano AS, Casebeer L, Patino F, Allison JJ, Weissman NW, Kiefe CI, Person S, Gilbert D, Saag KG (2003) Racial disparities in osteoporosis prevention in a managed care population. South Med J 96:445–451
Cauley JA, Robbins J, Chen Z, Cummings SR, Jackson RD, LaCroix AZ, LeBoff M, Lewis CE, McGowan J, Neuner J, Pettinger M, Stefanick ML, Wactawski-Wende J, Watts NB (2003) Effects of estrogen plus progestin on risk of fracture and bone mineral density: The women’s health initiative randomized trial. JAMA 290:1729–1738
Writing Group for the Women’s Health Initiative Investigators (2002) Risks and benefits of estrogen plus progestin in healthy postmenopausal women: principle results from the Women’s Health Initiative randomized controlled trial. JAMA 288:321–333
The Women’s Health Initiative Steering Committee (2004) Effects of conjugated equine estrogen in postmenopausal women with hysterectomy. JAMA 291:1701–1712
Siris ES, Miller PD, Barrett-Connor E, Faulkner KG, Wehren LE, Abbott TA, Berger ML, Santora AC, Sherwoon LM (2001) Identification and fracture outcomes of undiagnosed low bone mineral density in postmenopausal women. JAMA 286:2815–2822
Furstenberg AL, Mezey MD (1987) Differences in outcome between black and white elderly hip fracture patients. J Chronic Dis 40:931–938
Jacobsen SJ, Goldberg J, Miles TP, Brody JA, Stiers W, Rimm AA (1992) Race and sex differences in mortality following fracture of the hip. Am J Public Health 82:1147–1150
Agency for Healthcare Research and Quality. Overview of the Medical Expenditure Panel Survey.http://www.meps.ahrq.gov/WhatIsMEPS/Overview.htm, accessed 9 August 2004
Cohen SB (2003) Design strategies and innovations in the medical expenditure panel survey. Med Care 41:1115–1121
Agency for Healthcare Research and Quality (2000) MEPS HC-050: 2000 Full year consolidated data filehttp://www.meps.ahrq.gov/PufFiles/H50/H50doc.htm, accessed 9 March 2005
Andersen RM (1995) Revisiting the behavioral model and access to medical care: does it matter? J Health Soc Behav 36:1–10
Gold EB, Bromberger J, Crawford S, Samuels S, Greendale GA, Harlow SD, Skurnick J (2001) Factors associated with age at natural menopause in a multiethnic sample of midlife women. Am J Epidemiol 153:865–874
Adachi J (1997) Corticosteroid-induced osteoporosis. Am J Med Sci 313:41–49
Bonala SB, Reddy BM, Silverman BA, Bassett CW, Rao YA, Amaro S, Schneider AT (2000) Bone mineral density in women with asthma on long-term inhaled corticosteroid therapy. Ann Allergy Asthma Immunol 85:495–500
Matsumoto H, Ishihara K, Hasegawa T, Umeda B-I, Numi A, Hino M (2001) Effects of inhaled corticosteroid and short courses of oral corticosteroids on bone mineral density in asthmatic patients. Chest 120:1468–1473
Wong CA, Walsh LJ, Smith CJ, Wisniewski AF, Lewis SA, Hubbard R, Cawte S, Green DJ, Pringle M, Tattersfield AE (2000) Inhaled corticosteroid use and bone-mineral density in patients with asthma. Lancet 355:1399
Kubota F, Kifune A, Shibata N, Akata T, Takeuchi K, Takahashi S, Ohsawa M, Takama F (1999) Bone mineral density of epileptic patients on long-term antiepileptic drug therapy: a qualitative digital radiography study. Epilepsy Res 33:93–97
Sato Y, Kondo I, Ishida S, Motooka H, Takayama K, Tomita Y, Maeda H, Satoh K (2001) Decreased bone mass and increased bone turnover with valproate therapy in adults with epilepsy. Neurology 57:445–449
Sheth RD, Wesolowski CA, Jacob JC, Penney S, Hobbs GR, Riggs JE, Bodensteiner JB (1995) Effect of carbamazepine and valproate on bone mineral density. J Pediatr 127:256–262
Mattson RH, Gidal BE (2004) Fractures, epilepsy, and antiepileptic drugs. Epilepsy Behav 5:S36–S40
Fitzpatrick LA (2004) Pathophysiology of bone loss in patients receiving anticonvulsant therapy. Epilepsy Behav 5:S3–S15
Pack AM, Morrell MJ (2001) Adverse effects of antiepileptic drugs on bone structure: epidemiology, mechanisms, and therapeutic implications. CNS Drugs 15:633–642
Finelli PF, Cardi JK (1989) Seizure as a cause of fracture. Neurology 39:858–860
Institute of Medicine (2001) Coverage matters: insurance and health care. National Academy Press, Washington, DC
Ayanian JZ, Weissman JS, Schneider EC, Ginsburg JA, Zaslavsky AM (2000) Unmet health needs of uninsured adults in the United States. JAMA 284:2061–2069
Schoen C, DesRoches C (2000) Role of insurance in promoting access to care. Uninsured and unstably insured: the importance of continuous insurance coverage. Health Serv Res 35:187–206
Artz MB, Hadsall RS, Schondelmeyer SW (2002) Impact of generosity level of outpatient prescription drug coverage on prescription drug events and expenditure among older persons. Am J Public Health 92:1257–1263
StataCorp (2003). Stata statistical software: release 8.0. Stata Corporation, College Station, Tex
Rathore SS, Krumholz HM (2004) Differences, disparities, and biases: clarifying racial variations in health care use. Ann Intern Med 141:635–638
Hersh AL, Stefanick ML, Stafford RS (2004) National use of postmenopausal hormone therapy: annual trends and response to recent evidence. JAMA 291:47–53
Majumdar SR, Almasi EA, Stafford RS (2004) Promotion and prescribing of hormone therapy after report of harm by the Women’s Health Initiative. JAMA 292:1983–1988
Yates J, Barrett-Connor E, Barlas S, Chen Y-T, Miller P, Siris E (2004) Rapid loss of hip fracture protection after estrogen cessation: evidence from the national osteoporosis risk assessment. Obstet Gynecol 103:440–446
Cline RR, Farley JF, Hansen RA, Schommer JC (2005) Osteoporosis beliefs and antiresorptive drug use: a study in Minnesota. Maturitas 50:196–208
Kowalcek I, Rotte D, Banz C, Diedrich K (2005) Women’s attitude and perceptions towards menopause in different cultures: cross-cultural and intra-cultural comparison of pre-menopausal and post-menopausal women in Germany and in Papua New Guinea. Maturitas 51:227–235
Komesaroff PA, Kafanelis B, Black C, Cable V, Sudhir K, Daly J (2002) Experiences at menopause of women in a non-English speaking community: a qualitative study. Climacteric 5:78–86
Asch SM, Sloss EM, Hogan C, Brook RH, Kravitz RL (2000) Measuring underuse of necessary care among elderly Medicare beneficiaries using inpatient and outpatient claims. JAMA 284:2325–2333
Unson CG, Siccion E, Gaztambide J, Gaztambide S, Mahoney Trella P, Prestwood K (2003) Nonadherence and osteoporosis treatment preferences of older women: a qualitative study. J Womens Health 12:1037–1045
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Farley, J.F., Cline, R.R. & Gupta, K. Racial variations in antiresorptive medication use: results from the 2000 Medical Expenditure Panel Survey (MEPS). Osteoporos Int 17, 395–404 (2006). https://doi.org/10.1007/s00198-005-2027-9
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DOI: https://doi.org/10.1007/s00198-005-2027-9