Racial and socioeconomic disparities in bone density testing before and after hip fracture. J Gen Intern Med 2007 Sep;22(9):1239-45
Date
06/28/2007Pubmed ID
17594131Pubmed Central ID
PMC2219762DOI
10.1007/s11606-007-0217-1Scopus ID
2-s2.0-34547850471 (requires institutional sign-in at Scopus site) 51 CitationsAbstract
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.
Author List
Neuner JM, Zhang X, Sparapani R, Laud PW, Nattinger ABAuthors
Purushottam W. Laud PhD Professor in the Institute for Health and Equity department at Medical College of WisconsinAnn B. Nattinger MD, MPH Associate Provost, Professor in the Medicine department at Medical College of Wisconsin
Joan Neuner MD, MPH Professor in the Medicine department at Medical College of Wisconsin
Rodney Sparapani PhD Associate Professor in the Institute for Health and Equity department at Medical College of Wisconsin
MESH terms used to index this publication - Major topics in bold
AgedAged, 80 and over
Bone Density
Cohort Studies
Diagnostic Tests, Routine
Female
Florida
Hip Fractures
Humans
Illinois
New York
Retrospective Studies
Socioeconomic Factors
