Abstract
Introduction and hypothesis
An inverse relationship exists between socio-economic status (SES) and osteoporotic fractures. In publicly funded health-care systems there should be no barriers to accessing bone mineral density (BMD) testing, especially for those at increased fracture risk. Our hypothesis was that there would be a positive association between SES and BMD utilization (i.e. higher utilization rates in higher income women), resulting in disparities that disadvantage lower SES or lower income women.
Methods
A population-based BMD database from the Manitoba Bone Density Program was utilized to assess the association between SES (defined using income quintiles) and BMD utilization rates in women aged 50 years and older (n=107,944) for the 2001–2002 fiscal year. Analyses were stratified by age (50–64 years old and 65 years or older) and by a morbidity index obtained from the Johns Hopkins University Adjusted Clinical Group Case-Mix Adjustment System.
Results
Regression models demonstrated significantly higher BMD utilization rates among high SES women in all age and morbidity strata. Rate ratios varied from 1.76 (95% CI: 1.52–2.04) in 50- to 64-year-old women to 2.36 (95% CI: 1.60–3.49) in low morbidity women aged 65 or older.
Conclusion
Within the context of a publicly funded health-care system significant inverse associations are demonstrated between SES and BMD utilization rates. Further research is needed to better understand the nature of these associations and how they may contribute to health outcomes.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Evans RG, Stoddart GL (2003) Consuming research, producing policy? Am J Public Health 93:371–379
Farahmand BY, Persson PG, Michaelsson K, Baron JA, Parker MG, Ljunghall S (2000) Socioeconomic status, marital status and hip fracture risk: a population-based case-control study. Osteoporos Int 11:803–808
Varenna M, Binelli L, Zucchi F, Ghiringhelli D, Gallazzi M, Sinigaglia L (1999) Prevalence of osteoporosis by educational level in a cohort of postmenopausal women. Osteoporos Int 9:236–241
Bacon WE, Hadden WC (2000) Occurrence of hip fractures and socioeconomic position. J Aging Health 12:193–203
Demeter S, Reed M, Lix L, MacWilliam L, Leslie WD (2005) The association between socio-economic status and the utilization of diagnostic imaging in an urban Canadian setting. Can Med Assoc J 173:1173–1177
Leslie WD, Metge C (2003) Establishing a regional bone density program: lessons from the Manitoba experience. J Clin Densitom 6:275–282
Leslie WD, Caetano PA, Macwilliam LR, Finlayson GS (2005) Construction and validation of a population-based bone densitometry database. J Clin Densitom 8:25–30
Roos NP, Shapiro E (1999) Revisiting the Manitoba centre for health policy and evaluation and its population-based health information system. Med Care 37:JS10–JS14
Roos NP (1999) Establishing a population data-based policy unit. Med Care 37[Suppl 6]:JS15–JS26
Demeter S, Reed M, Lix L, MacWilliam L (2004) Is there an association between socioeconomic factors and the per capita utilization of selected medical imaging modalities? In: Finlayson G, Leslie W, MacWilliam L (eds) Diagnostic imaging data in Manitoba: assessment and applications. Manitoba Centre for Health Policy, University of Manitoba, Winnipeg
Income Quintiles Based on the 1996 Census (2003) Winnipeg, MB. Manitoba Centre for Health Policy. Available at http://www.umanitoba.ca/academic/centres/mchp/concept/diet/income/income_quintile.html (Last accessed June 11, 2005)
Starfield B, Weiner J, Mumford L, Steinwachs D (1991) Ambulatory care groups: a categorization of diagnoses for research and management. Health Serv Res 26:53–74
Weiner JP, Starfield BH, Steinwachs DM, Mumford LM (1991) Development and application of a population-oriented measure of ambulatory care case-mix. Med Care 29:452–472
Smith NS, Weiner JP (1994) Applying population-based case mix adjustment in managed care: the Johns Hopkins ambulatory care group system. Manag Care Q 2:21–34
Reid RJ, Roos NP, MacWilliam L, Frohlich N, Black C (2002) Assessing population health care need using a claims-based age morbidity measure: a validation analysis in the Province of Manitoba. Health Serv Res 37:1345–1364
Finkelstein MM (2002) Preventive screening. What factors influence testing? Can Fam Physician 48:1494–1501
Wang MC, Dixon LB (2006) Socioeconomic influences on bone health in postmenopausal women: findings from NHANES III, 1988–1994. Osteoporos Int 17:91–98
Brennan RM, Wactawski-Wende J, Crespo CJ, Dmochowski J (2004) Factors associated with treatment initiation after osteoporosis screening. Am J Epidemiol 160:475–483
Government of Canada, Canada Health Act.1984, c. 6
Rossignol M, Moride Y, Perreault S, Boivin JF, Ste-Marie LG, Robitaille Y, Poulin de Courval L, Fautrel B (2002) Recommendations for the prevention of osteoporosis and fragility fractures. International comparison and synthesis. Int J Technol Assess Health Care 18:597–610
Acknowledgments
This work was supported within the framework of the project “Diagnostic Imaging Data in Manitoba: Assessment and Applications,” one of several projects undertaken each year by the Manitoba Centre for Health Policy under contract to Manitoba Health. The results and conclusions are those of the authors, and no official endorsement by Manitoba Health is intended or should be inferred.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Demeter, S., Leslie, W.D., Lix, L. et al. The effect of socioeconomic status on bone density testing in a public health-care system. Osteoporos Int 18, 153–158 (2007). https://doi.org/10.1007/s00198-006-0212-0
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00198-006-0212-0