BACKGROUND: Racial and socioeconomic disparities have been identified in osteoporosis screening. OBJECTIVE: To determine whether racial and socioeconomic disparities in osteoporosis screening diminish after hip fracture. DESIGN: Retrospective cohort study of female Medicare patients. SETTING: Entire states of Illinois, New York, and Florida. PARTICIPANTS: Female Medicare recipients aged 65-89 years old with hip fractures between January 2001 and June 2003. MEASUREMENTS: 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. RESULTS: 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. CONCLUSIONS: 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.
BACKGROUND: Racial and socioeconomic disparities have been identified in osteoporosis screening. OBJECTIVE: To determine whether racial and socioeconomic disparities in osteoporosis screening diminish after hip fracture. DESIGN: Retrospective cohort study of female Medicare patients. SETTING: Entire states of Illinois, New York, and Florida. PARTICIPANTS: Female Medicare recipients aged 65-89 years old with hip fractures between January 2001 and June 2003. MEASUREMENTS: 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. RESULTS: 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. CONCLUSIONS: 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.
Authors: S T Harris; N B Watts; H K Genant; C D McKeever; T Hangartner; M Keller; C H Chesnut; J Brown; E F Eriksen; M S Hoseyni; D W Axelrod; P D Miller Journal: JAMA Date: 1999-10-13 Impact factor: 56.272
Authors: U A Liberman; S R Weiss; J Bröll; H W Minne; H Quan; N H Bell; J Rodriguez-Portales; R W Downs; J Dequeker; M Favus Journal: N Engl J Med Date: 1995-11-30 Impact factor: 91.245
Authors: J A Grisso; J L Kelsey; B L Strom; L A O'Brien; G Maislin; K LaPann; L Samelson; S Hoffman Journal: N Engl J Med Date: 1994-06-02 Impact factor: 91.245
Authors: S R Cummings; D M Black; D E Thompson; W B Applegate; E Barrett-Connor; T A Musliner; L Palermo; R Prineas; S M Rubin; J C Scott; T Vogt; R Wallace; A J Yates; A Z LaCroix Journal: JAMA Date: 1998 Dec 23-30 Impact factor: 56.272
Authors: Amy H Warriner; Ryan C Outman; Adrianne C Feldstein; Douglas W Roblin; Jeroan J Allison; Jeffrey R Curtis; David T Redden; Mary M Rix; Brandi E Robinson; Ana G Rosales; Monika M Safford; Kenneth G Saag Journal: Med Care Date: 2014-08 Impact factor: 2.983
Authors: Nicole C Wright; Mary E Melton; Maira Sohail; Ivan Herbey; Susan Davies; Emily B Levitan; Kenneth G Saag; Natalia V Ivankova Journal: J Racial Ethn Health Disparities Date: 2019-02-11
Authors: Stephen K Liu; Jeffrey C Munson; John-Erik Bell; Rebecca L Zaha; John N Mecchella; Anna N A Tosteson; Nancy E Morden Journal: J Am Geriatr Soc Date: 2013-10-28 Impact factor: 5.562