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Racial and Socioeconomic Disparities in Bone Density Testing Before and After Hip Fracture

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Abstract

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.

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Acknowledgements

Presented at the 28th Annual Society of General Internal Medicine meeting in New Orleans, LA, May 12–14 2005. The study was funded by the National Institutes of Health, which had no role in determining the study design, analysis, interpretation of the data, writing of the report, or decision to submit the paper for publication. Grant support: PHS NIA #K08-AG021631 to Dr. Neuner.

Conflict of Interest

None disclosed.

Author information

Authors and Affiliations

  1. Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA

    Joan M. Neuner MD, MPH & Ann B. Nattinger MD, MPH

  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

    Joan M. Neuner MD, MPH, Rodney Sparapani MS, Purushottam W. Laud PhD & Ann B. Nattinger MD, MPH

  3. Department of Mathematics and Statistics, Georgia State University, Atlanta, GA, USA

    Xu Zhang PhD

Authors
  1. Joan M. Neuner MD, MPH
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  2. Xu Zhang PhD
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  3. Rodney Sparapani MS
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  4. Purushottam W. Laud PhD
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  5. Ann B. Nattinger MD, MPH
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Corresponding author

Correspondence to Joan M. Neuner MD, MPH.

Appendix

Appendix

Table 3 Algorithm for identifying hip fractures
Full size table

Inclusion criteria:

  1. IC 1

    Continously enrolled in non-health maintenance organization, Medicare parts A and B January 1999 to December 2003

  2. IC 2

    White, black, and Hispanic females

  3. IC 3

    Continuously residing in Florida, Illinois, or New York from 1999 to 2003

  4. IC 4

    Aged +65 years old as of January 1 1999

  5. IC 5

    Residential zip code available and corresponding U.S. Census data available

  6. IC 6

    Each patient has at least one of the following:

    1. (a)

      An inpatient SAF claim with a hip/femoral shaft fracture discharge diagnosis

    2. (b)

      An inpatient SAF claim with a hip fracture hospital procedure

    3. (c)

      An inpatient SAF claim with a hip/femoral shaft fracture admission diagnosis and/or a carrier SAF claim with a hip/femoral shaft fracture diagnosis

    4. (d)

      A carrier SAF claim with a hip/femoral shaft fracture physician identification procedure

    5. (e)

      A carrier SAF claim with a hip/femoral shaft fracture physician confirmation procedure

Exclusion criteria:

  1. EC 1

    Care of anthroplasty, old fracture, or other bone disease

  2. EC 2

    Orthopedic surgeon claims present with no identification nor confirmation procedures

  3. EC 3

    Hospital procedure only

  4. EC 4

    Hospital admission diagnosis and/or physician diagnosis only

  5. EC 5

    Physician confirmation procedure only

  6. EC 6

    A hip fracture found prior to January 1 2001

  7. EC 7

    No hip fracture found during the period from January 1 2001 to June 30 2003

  8. EC 8

    Age at time of fracture >90 years

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Neuner, J.M., Zhang, X., Sparapani, R. et al. Racial and Socioeconomic Disparities in Bone Density Testing Before and After Hip Fracture. J GEN INTERN MED 22, 1239–1245 (2007). https://doi.org/10.1007/s11606-007-0217-1

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  • DOI: https://doi.org/10.1007/s11606-007-0217-1

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