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

Abstract

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.

Socioeconomic and living conditions are determinants of hip fracture incidence and age occurrence among community-dwelling elderly

“…Unhealthy behaviors (poor diet, cigarette smoking, physical inactivity during leisure time, and alcohol consumption-other than moderate) during the life span are indeed more prevalent in lower socioeconomic status groups [34][35][36] and they are associated with higher risk of hip fracture [37] and with higher rates of injuries caused by falls [38]. Another explanation could be the lower propensity of low socioeconomic status groups to undergo bone density testing before fracture [39]. An additional theory could be a higher exposure to environmental health risks, such as less adequate build environment or a lower likelihood of treatment [40].…”

Minimizing Disparities in Osteoporosis Care of Minorities With an Electronic Medical Record Care Plan

“…However, differences in testing between ethnic groups were not observed when using zip code as a surrogate for socioeconomic characteristics, since bone density testing rates after hip fracture were similar in lowand high-income groups [10].…”

“…Epstein et al [7] found ethnic minorities were less likely to be treated by highvolume surgeons at high-volume hospitals, with African Americans operated on by low-volume surgeons in lowvolume hospitals in nine of 10 procedures across the surgical spectrum studied at New York City area hospitals. Ethnic disparities in care have been recently documented in osteoporosis care [1,2,10,12,14]. Neuner et al [10] reported African American and Hispanic women were less likely to undergo bone density testing before index hip fracture compared to white women and this phenomenon Each author certifies that he or she has no commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article.…”

“…Ethnic disparities in care have been recently documented in osteoporosis care [1,2,10,12,14]. Neuner et al [10] reported African American and Hispanic women were less likely to undergo bone density testing before index hip fracture compared to white women and this phenomenon Each author certifies that he or she has no commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article. Each author certifies that his or her institution approved the human protocol for this investigation, that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained.…”

Physician Tiering by Health Plans in Massachusetts

“…From the 2000 United States Census (www.census.gov), we then gathered data on the practice zip code's population density, the percentage of individuals below the poverty level, and median household income. This approach to demographic data has been used in a number of other studies [3][4][5][6][7][8] . Population density data were further used to classify a surgeon's practice setting as urban (>3000 persons per square mile), suburban (1000 to 3000 persons per square mile), or rural (<1000 persons per square mile).…”