title: Effects of health insurance on racial disparity in osteoporosis medication adherence.
abstract: OBJECTIVE
  To explore whether racial disparity in osteoporosis drug therapy maintenance varies by health insurance coverage status.
  
  
  METHODS
  Longitudinal observation study.
  
  
  METHODS
  Cleveland Clinic Health System (Cleveland, OH) from January 2006 to December 2009.
  
  
  METHODS
  3,901 black and white female Medicare beneficiaries starting osteoporosis drug therapy.
  
  
  METHODS
  Analysis of the health system's integrated electronic medical records.
  
  
  METHODS
  Drug therapy adherence (medication possession ratio ≥80%) for more than 12 of 15 surveillance units and occurrence of extended nonadherence gaps for at least two surveillance units in a row.
  
  
  RESULTS
  Among patients with supplementary health insurance (n = 2,278), no difference was observed for drug therapy adherence ( P = 0.17) and extended nonadherence gaps ( P = 0.53) between black and white participants. When patients did not have supplementary health insurance (n = 1,623), blacks (36% [95% CI 28-47]) were less likely to adhere to drug therapy than whites (47% [38-57]; odds ratio [OR] 0.34 [95% CI 0.09-0.92], P = 0.004). Blacks (25% [19-32]) also were more likely to have an extended nonadherence gap episode than whites (18% [11-26]; OR 2.42 [1.13-3.50], P = 0.03).
  
  
  CONCLUSIONS
  Similar to previous research on racial disparity in health services, racial disparity in osteoporosis drug therapy maintenance between black and white female older patients existed when supplementary health insurance was not affordable.
authors.forename: Ji Won
authors.initials: JW
authors.lastname: Yoo
authors.forename: Sulgi
authors.initials: S
authors.lastname: Kim
authors.forename: Sun Jung
authors.initials: SJ
authors.lastname: Kim
authors.forename: Woo Sang
authors.initials: WS
authors.lastname: Ryu
authors.forename: Too Jae
authors.initials: TJ
authors.lastname: Min
authors.forename: Hyun Phil
authors.initials: HP
authors.lastname: Shin
authors.forename: Kyudam
authors.initials: K
authors.lastname: Kim
authors.forename: Jong Bum
authors.initials: JB
authors.lastname: Choi
authors.forename: Shunichi
authors.initials: S
authors.lastname: Nakagawa
mesh_terms: D001741:Black or African American / Q000706:statistics & numerical data*; D000368:Aged; D000369:Aged, 80 and over; D057286:Electronic Health Records; D005260:Female; D006801:Humans; D019458:Insurance Coverage / Q000706:statistics & numerical data; D007348:Insurance, Health / Q000706:statistics & numerical data; D008137:Longitudinal Studies; D006278:Medicare; D055118:Medication Adherence / Q000208:ethnology; D009820:Ohio; D010024:Osteoporosis / Q000188:drug therapy*; D014481:United States; D044465:White People / Q000706:statistics & numerical data*; D016903:Drug Monitoring