Racial and socioeconomic disparities in bone density testing before and after hip fracture.
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.


METHODS
Retrospective cohort study of female Medicare patients.


METHODS
Entire states of Illinois, New York, and Florida.


METHODS
Female Medicare recipients aged 65-89 years old with hip fractures between January 2001 and June 2003.


METHODS
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.
Neuner
Joan M
JM
Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA. jneuner@mcw.edu
Zhang
Xu
X
Sparapani
Rodney
R
Laud
Purushottam W
PW
Nattinger
Ann B
AB
D000368:Aged; D000369:Aged, 80 and over; D044383:Black People / Q000208:ethnology*; D015519:Bone Density / Q000502:physiology; D015331:Cohort Studies; D003955:Diagnostic Tests, Routine / Q000706:statistics & numerical data; D005260:Female; D005431:Florida / Q000208:ethnology; D006620:Hip Fractures / Q000175:diagnosis / Q000191:economics / Q000208:ethnology*; D006630:Hispanic or Latino / Q000208:ethnology*; D006801:Humans; D007087:Illinois / Q000208:ethnology; D009518:New York / Q000208:ethnology; D012189:Retrospective Studies; D012959:Socioeconomic Factors; D044465:White People / Q000208:ethnology*; D001741:Black or African American