Vaughan Sarrazin MS (Iowa City VA Center of Excellence), Safford M
(University of Alabama - Birmingham), Richardson KK
(Iowa City VA Center of Excellence), Cram P
(University of Iowa College of Medicine)
Evaluate differences in treatment and mortality of black and white veterans admitted for hip fracture.
Black (n = 781) and white (n = 5,712) patients admitted to VA hospitals for hip fracture during FY2004-07 with no diagnosis of osteoporosis or bisphosphonate (BP) use during the 12 months preceding admission were identified using VA inpatient, outpatient, and pharmacy data. Three events occurring within 6 months of hip fracture admission were evaluated: 1) death; 2) osteoporosis diagnosis as identified by ICD-9 code; and 3) BP initiation. Logistic regression and Cox regression models were used to examine mortality, osteoporosis diagnosis, and BP initiation after hip fracture for black and white patients, controlling for patient age, sex, income, rural location, and comorbidity.
Compared to white patients, blacks were younger, less likely to be female, had lower incomes, and were less likely to live in a rural setting. Unadjusted mortality within 6 months of admission was similar among black and white patients (26.5% vs. 25.5%; p = .52), while the rate of osteoporosis diagnosis was significantly higher among white patients (18.0% vs. 14.6% of white and black patients, respectively; p = .02), as was the rate of BP initiation among all patients (9.4% vs. 4.8%; p < .001). Initiation of BP therapy among the 1,171 fracture patients subsequently diagnosed with osteoporosis was low (29%), with BP use significantly higher for whites than blacks (31% vs. 18.1%; p = .004). In regression models, risk-adjusted mortality remained similar for blacks and whites (Odds Ratio = 1.07; 95% CI, 0.88-1.29; p = .50). The risk-adjusted hazard of bisphosphonate use for blacks, relative to whites, was 0.53 (95% CI, 0.38-0.73; p < .001) among all hip fracture patients and was 0.58 (95% CI, 0.37-0.90; p = .01) among patients diagnosed with osteoporosis.
Both black and white veterans are unlikely to receive BP therapy following hip fracture, even when osteoporosis is diagnosed. Black veterans are less likely to be diagnosed with osteoporosis and receive BP therapy than whites, but mortality for blacks and whites is similar.
Veterans with hip fracture frequently receive suboptimal osteoporosis treatment. Disparities in osteoporosis treatment exist even among veteran populations with similar access to diagnostic testing and pharmacy benefits.