Abstract
To determine the effect modification of supplemental insurance on the relationship between race and bone mineral density (BMD) in female Medicare beneficiaries. Retrospectively analyzing hospital administrative claim and clinical data of female Medicare beneficiaries (n = 1,398), we performed multivariate logistic regressions of BMD testing including data from all study participants and the subsets of health insurance. Significantly fewer Black than White female Medicare beneficiaries received the BMD testing in the overall sample (odds ratio, OR = 0.63; p = 0.02) and those without supplementary health insurance (n = 709; OR = 0.38; p = 0.004). By contrast, the magnitude of this racial disparity in the BMD testing was diminished among those with supplementary private health insurance (n = 689). We found a significant racial disparity in BMD testing for Black and White female Medicare beneficiaries. This disparity became more pronounced among those without supplementary private health insurance.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Firestein GS, Kelly WN. Kelly’s textbook of rheumatology. 8th ed. Philadelphia: Saunders/Elsevier; 2009.
Halter JB, Studenski S, Oudlander JG, High KP, Tinetti ME, Asthana S. Hazzard’s geriatric medicine and gerontology. 6th ed. New York: McGraw-Hill Inc.; 2010.
National Osteoporosis Foundation. The clinician’s guide to prevention and treatment of osteoporosis. Available at http://www.nof.org/sites/default/NOF_clinicianguide2009_v7.pdf. Assessed 10 Jan 2012.
Bone mass measurement. Medicare Learning Network®: The guide to Medicare Preventive Services. Center for Medicare and Medicaid Services, Washington DC. (ICN 006439) Available at http://www.cms.gov/MLNproducts/downloads/mps_guide_web-061305.pdf. Assessed 9 Jan 2012.
Kanis JA. on behalf of the World Health Organization Scientific Group. Assessment of osteoporosis at the primary health care level. Technical Report. University of Sheffield, UK; 2008.
Pothiwala P, Evans EM, Chapman-Novakofski KM. Ethnic variation in risk for osteoporosis among women: a review of biological and behavioral factors. J Womens Health (Larchmt). 2006;15:709–19.
Siris ES, Miller PD, Barrett-Connor E, Faulkner KG, Wehren LE, Abbott TA, Berger ML, Santora AC, Sherwood LM. Identification and fracture outcomes of undiagnosed low bone mineral density in postmenopausal women: results from the National Osteoporosis Risk Assessment. JAMA. 2001;286:2815–22.
Miller RG, Ashar BH, Cohen J, Camp M, Coombs C, Johnson E, Schneyer CR. Disparities in osteoporosis screening between at risk African American and White women. J Gen Intern Med. 2005;20:847–51.
Wilkins CH, Goldfeder JS. Osteoporosis screening is unjustifiably low in older African-American women. J Natl Med Assoc. 2004;96:461–7.
Neuman MD, Kennelly AM, Tosi LL. Breakout session: sex/gender and racial/ethnic disparities in the care of osteoporosis and fragility fractures. Clin Orthop Relat Res. 2011;469:1936–40.
Sadler C, Huff M. African‐American women: health beliefs, lifestyle, and osteoporosis. Orthop Nurs. 2007;26:96–101.
Kessenich CR. Osteoporosis and African-American women. Womens Health Issues. 2000;10:300–4.
Mudano AS, Casebeer L, Patino F, Allison JJ, Weissman NW, Kiefe CI, Person S, Gilbert D, Saag KG. Racial disparities in osteoporosis prevention in a managed care population. South Med J. 2003;96:445–51.
Gourlay ML, Callahan LF, Preisser JS, Sloane PD. Osteoporosis preventive care in white and black women in community family medicine settings. South Med J. 2007;100:677–82.
Binkley NC, Schmeer P, Wasnich RD, Lenchik L. What are the criteria by which a densitometry diagnosis of osteoporosis can be made in males and non-Caucasians? J Clin Densitom. 2002;5(Suppl):19.
Kim HS. Older women’s health and its impact on wealth. J Women Aging. 2006;18:75–91.
Thorpe RJ Jr, Koster A, Bosma H, Harris TB, Simonsick EM, van Eijk JT, Kempen GI, Newman AB, Satterfield S, Rubin SM, Kritchevsky SB; for the Health ABC Study. Racial differences in mortality in older adults: factors beyond socioeconomic status. Ann Behav Med. 2011. doi:10.1007/s12160-011-9335-4 [Epub ahead of print].
Whitson HE, Hastings SN, Landerman LR, Fillenbaum GG, Cohen HJ, Johnson KS. Black-white disparity in disability: the role of medical conditions. J Am Geriatr Soc. 2011;59:844–50.
Curtis JR, Carbone L, Cheng H, Hayes B, Laster A, Mattews R, Saag KG, Sepanski R, Tanner SB, Delzell E. Longitudinal trends in use of bone mass measurement among older Americans, 1999–2005. J Bone Miner Res. 2008;23:1061–7.
Hulley SB, Cummings SR, Browner WS, Grady D, Hearst N, Newman TB. Design clinical research. 2nd ed. Philadelphia: Lippincott Williams & Wilkins; 2001.
Stokes ME, Davis CS, Koch GG. Categorical data analysis using the SAS System. 2nd ed. Cary: SAS; 2009.
Hosmer DW, Lemeshow S. Applied logistic regression. 2nd ed. Hoboken: Wiley; 2005.
National Institute on Alcohol Abuse and Alcoholism. The physician’s guide to helping patients with alcohol problems. (Publication NIH 95-3769). Washington DC: Government Printing Office; 1995.
McNally DN, Kenny AM, Smith JA. Adherence of academic geriatric practitioners to osteoporosis screening guidelines. Osteoporosis Int. 2007;18:177–83.
Tanner SB. Dual-energy X-ray absorptiometry in clinical practice: new guidelines and concerns. Curr Opin Rheumatol. 2011;23:385–8.
Cadarette SM, Gignac MA, Jaglal SB, Beaton DE, Hawker GA. Access to osteoporosis treatment is critically linked to access to dual-energy X-ray absorptiometry testing. Med Care. 2007;45:896–901.
Lewiecki EM, Baim S, Siris ES. Osteoporosis care at risk in the United States. Osteoporos Int. 2008;19:1505–9.
Breen N, Gentleman JF, Schiller JS. Update on mammography trends: comparisons of rates in 2000, 2005, and 2008. Cancer. 2011;117:2209–18.
Stolzmann KL, Bautista LE, Gangnon RE, McElroy JA, Becker BN, Remington PL. Trends in kidney transplantation rates and disparities. J Natl Med Assoc. 2007;99:923–32.
Smith DB, Feng Z, Fennell ML, Zinn JS, Mor V. Separate and unequal: racial segregation and disparities in quality across U.S. nursing homes. Health Aff (Millwood). 2007;26:1448–58.
Lepore MJ, Miller SC, Gozalo P. Hospice use among urban Black and White U.S. nursing home decedents in 2006. Gerontologist. 2011;51:251–60.
King AB, Fiorentino DM. Medicare payment cuts for osteoporosis testing reduced use despite tests’ benefit in reducing fractures. Health Aff (Millwood). 2011;30:2362–70.
Zhang J, Delzell E, Zhao H, Laster AJ, Saag KG, Kilgore ML, Morrisey MA, Wright NC, Yun H, Curtis JR. Central DXA utilization shifts from office-based to hospital-based settings among Medicare beneficiaries in the wake of reimbursement changes. J Bone Miner Res; 2011. doi:10.1002/jbmr.1534 [Epub ahead of print].
Acknowledgments
All authors disclose NO financial and personal relationships with other people or organizations that could inappropriately influence (bias) their work. This project was supported by the American Geriatrics Society Seed Grant Research Program. The funding source had no role in design and conduct of the study; collection, management, analysis, and interpretation of the data; and preparation, review, or approval of the manuscript. We thank Pil Park, PhD (University of Michigan Medical School) and Daehyun Kim, M.D., M.P.H. (Harvard Medical School) for their precious feedbacks on study design, analysis interpretation, and manuscript preparation.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Yoo, J.W., Nakagawa, S. & Kim, S. The Effect Modification of Supplemental Insurance on the Relationship Between Race and Bone Mineral Density Screening in Female Medicare Beneficiaries. J Immigrant Minority Health 14, 912–917 (2012). https://doi.org/10.1007/s10903-012-9629-z
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10903-012-9629-z