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Racial Differences and Disparities in Osteoporosis-related Bone Health

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Background:

Determining whether observed differences in health care can be called disparities requires persistence of differences after adjustment for relevant patient, provider, and health system factors. We examined whether providing dual-energy x-ray absorptiometry (DXA) test results directly to patients might reduce or eliminate racial differences in osteoporosis-related health care.

Design, Subjects, and Measures:

We analyzed data from 3484 white and 1041 black women who underwent DXA testing at 2 health systems participating in the Patient Activation after DXA Result Notification (PAADRN) pragmatic clinical trial (ClinicalTrials.gov NCT-01507662) between February 2012 and August 2014. We examined 7 outcomes related to bone health at 12 weeks and 52 weeks post-DXA: (1) whether the patient correctly identified their DXA baseline results; (2) whether the patient was on guideline-concordant osteoporosis pharmacotherapy; (3) osteoporosis-related satisfaction; (4) osteoporosis knowledge; (5 and 6) osteoporosis self-efficacy for exercise and for diet; and (7) patient activation. We examined whether unadjusted differences in outcomes between whites and blacks persisted after adjusting for patient, provider, and health system factors.

Results:

Mean age was 66.5 years and 29% were black. At baseline black women had less education, poorer health status, and were less likely to report a history of osteoporosis (P<0.001 for all). In unadjusted analyses black women were less likely to correctly identify their actual DXA results, more likely to be on guideline-concordant therapy, and had similar patient activation. After adjustment for patient demographics, baseline health status and other factors, black women were still less likely to know their actual DXA result and less likely to be on guideline-concordant therapy, but black women had greater patient activation.

Conclusions:

Adjustment for patient and provider level factors can change how racial differences are viewed, unmasking new disparities, and providing explanations for others.
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Keywords: dual-energy x-ray absorptiometry; osteoporosis; randomized controlled trials; risk communication

Document Type: Research Article

Affiliations: 1: Department of Medicine, University of Toronto, Division of General Internal Medicine and Geriatrics, Mt. Sinai/UHN Hospitals, Toronto, ON, Canada, Department of Internal Medicine, Division of General Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA 2: Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham, Birmingham, AL 3: Departments of Biostatistics 4: Health Management and Policy, University of Iowa College of Public Health, University of Iowa College of Nursing, CADRE, Iowa City VA Healthcare System, Iowa City, IA 5: Health Management and Policy, University of Iowa College of Public Health 6: Kaiser Permanente, School of Public Health, Georgia State University, Atlanta, GA 7: Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham, Birmingham, AL, Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL 8: Health Management and Policy, University of Iowa College of Public Health, University of Iowa College of Nursing

Publication date: June 1, 2017

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