Disparities in osteoporosis screening between at-risk African-American and white women

Miller, Redonda G.; Ashar, Bimal H.; Cohen, Jennifer; Camp, Melissa; Coombs, Carmen; Johnson, Elizabeth; Schneyer, Christine R.

doi:10.1111/j.1525-1497.2005.0157.x

Cited by 51 publications

(40 citation statements)

References 25 publications

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“…Demographic variables were age, sex, income, nativity (US born), and marital status. [7][8][9][10][11][12]13 Statistical Analysis Statistical analyses, which included the health literacy measure, were carried out using AM software, 28 the only software that can be used for secondary analyses of the NAAL literacy data with its complex sampling design. This software estimates regression models involving a literacy variable through the marginal maximum likelihood (MML) method.…”

Section: Methodsmentioning

confidence: 99%

“…[5][6][7][8][9] Particularly troubling are disparities in the use and delivery of immunizations and cancer screening related to race/ethnicity and educational attainment. [6][7][8][9][10][11][12] It is commonly thought that health literacy (the ability to use health information from any source to make appropriate health decisions) is an important contributor to these disparities. 13,14 Despite calls for research in this area, there has been little effort to assess formally the contribution of health literacy to disparities in health.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

The Contribution of Health Literacy to Disparities in Self-Rated Health Status and Preventive Health Behaviors in Older Adults

Bennett

Chen

Soroui

et al. 2009

The Annals of Family Medicine

441

344

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PURPOSE Health literacy is associated with a range of poor health-related outcomes. Evidence that health literacy contributes to disparities in health is minimal and based on brief screening instruments that have limited ability to assess health literacy. The purpose of this study was to assess whether health literacy contributes, through mediation, to racial/ethnic and education-related disparities in self-rated health status and preventive health behaviors among older adults. METHODSWe undertook a cross-sectional study of a nationally representative sample of 2,668 US adults aged 65 years and older from the 2003 National Assessment of Adult Literacy. Multiple regression analysis was used to assess for evidence of mediation. RESULTSOf older adults in the United States, 29% reported fair or poor health status, and 27% to 39% reported not utilizing 3 recommended preventive health care services in the year preceding the assessment (infl uenza vaccination 27%, mammography 34%, dental checkup 39%). Health literacy and the 4 health outcomes (self-rated health status and utilization of the 3 preventive health care services) varied by race/ethnicity and educational attainment. Regression analyses indicated that, after controlling for potential confounders, health literacy significantly mediated both racial/ethnic and education-related disparities in self-rated health status and receipt of infl uenza vaccination, but only education-related disparities in receipt of mammography and dental care.CONCLUSIONS Health literacy contributes to disparities associated with race/ethnicity and educational attainment in self-rated health and some preventive health behaviors among older adults. Interventions addressing low health literacy may reduce these disparities.

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Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

The Contribution of Health Literacy to Disparities in Self-Rated Health Status and Preventive Health Behaviors in Older Adults

Bennett

Chen

Soroui

et al. 2009

The Annals of Family Medicine

441

344

View full text Add to dashboard Cite

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“…Although the prevalence of osteoporosis and related fragility fracture is lower in African American women compared with white women, osteoporosis is not uncommon in the African American adult population 70,71 and may be underdiagnosed. 72 Additional study is needed to better understand and improve bone health in the African American population given our study findings of an increased prevalence of factors associated with forearm fracture risk, [24][25][26][27][28][29][30] higher rates of some fractures, 32,33 and the apparent paradox of a relatively increased BMD in comparison with white children. 31 …”

Section: Discussionmentioning

confidence: 99%

Bone Mineral Density and Vitamin D Status Among African American Children With Forearm Fractures

2012

PEDIATRICS

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WHAT'S KNOWN ON THIS SUBJECT: Forearm fractures are unique injuries which are associated with lower bone mineral density in adults and white children. The relationships among bone mineral density, 25-hydroxyvitamin D status, and risk for forearm fracture have not been investigated in African American children. WHAT THIS STUDY ADDS:Our data support an association between both lower bone mineral density and vitamin D deficiency and increased odds of forearm fracture in African American children. Promotion of bone health is indicated in this population.abstract OBJECTIVE: To determine whether African American children with forearm fractures have decreased bone mineral density and an increased prevalence of vitamin D deficiency (serum 25-hydroxyvitamin D level #20 ng/mL) compared with fracture-free control patients. METHODS:This case-control study in African American children, aged 5 to 9 years, included case patients with forearm fracture and control patients without fracture. Evaluation included measurement of bone mineral density and serum 25-hydroxyvitamin D level. Univariable and multivariable analyses were used to test for associations between fracture status and 2 measures of bone health (bone mineral density and 25-hydroxyvitamin D level) while controlling for other potential confounders. RESULTS:The final sample included 76 case and 74 control patients. There were no significant differences between case and control patients in age, gender, parental education level, enrollment season, outdoor play time, height, or mean dietary calcium nutrient density. Cases were more likely than control patients to be overweight (49.3% vs 31.4%, P = .03). Compared with control patients, case patients had lower whole body z scores for bone mineral density (0.62 6 0.96 vs 0.98 6 1.09; adjusted odds ratio 0.38 [0.20-0.72]) and were more likely to be vitamin D deficient (47.1% vs 40.8%; adjusted odds ratio 3.46 [1.09-10.94]). CONCLUSIONS:These data support an association of lower bone mineral density and vitamin D deficiency with increased odds of forearm fracture among African American children. Because suboptimal childhood bone health also negatively impacts adult bone health, interventions to increase bone mineral density and correct vitamin D deficiency are indicated in this population to provide short-term and long-term benefits. Pediatrics 2012;130:e553-e560

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“…Decreased bone mineral density increases fracture risk across multiple racial groups [7]; however, rates of screening and treatment for osteoporosis are lower among minorities than among whites, both within populations at risk for osteoporosis [11,21] and among patients who have already sustained a fracture [20,26]. Similarly, the hospital treatment of fragility fractures differs among racial groups: African American Medicare beneficiaries receive indicated operative repair for hip fracture at lower rates than comparable white patients [25].…”

Section: Introductionmentioning

confidence: 99%

“…Multiple studies in the medical literature support these concerns, documenting underdiagnosis and undertreatment of osteoporosis, among both at-risk individuals without fracture [12,22,27] and those who sustained a fragility fracture [18,31]. While most of these studies have focused on white and Asian women, emerging evidence suggests shortcomings in the diagnosis and treatment of osteoporosis may be most pronounced in racial and ethnic minorities [21] and men [32], even within health systems with high overall rates of screening and treatment of patients at risk for fracture [24].…”

Section: Introductionmentioning

confidence: 99%

Breakout Session: Sex/Gender and Racial/Ethnic Disparities in the Care of Osteoporosis and Fragility Fractures

Neuman

Kennelly

Tosi

2011

Clinical Orthopaedics &Amp; Related Research

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Disparities in osteoporosis screening between at-risk African-American and white women

Cited by 51 publications

References 25 publications

The Contribution of Health Literacy to Disparities in Self-Rated Health Status and Preventive Health Behaviors in Older Adults

The Contribution of Health Literacy to Disparities in Self-Rated Health Status and Preventive Health Behaviors in Older Adults

Bone Mineral Density and Vitamin D Status Among African American Children With Forearm Fractures

Breakout Session: Sex/Gender and Racial/Ethnic Disparities in the Care of Osteoporosis and Fragility Fractures

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