Ethnicity, Ethnic Language, and Fracture Risk Conditions in Women Initiating Osteoporosis Therapy

Abstract Introduction: The ethnic diversity of women with osteoporosis has increased, but data on acculturation and health remain limited. Having a primary language (PL) other than English may reflect acculturation level and/or immigration as an adult. We used electronic health record (EHR) data from a large US health plan to examine the association of baseline clinical risk conditions and PL among US Chinese and US Hispanic women who initiated osteoporosis therapy. Methods: We identified women age 65-74y who initiated osteoporosis therapy in 2002–2014, excluding those with skeletal disorders, advanced kidney disease and metastatic cancer. PL was ascertained from the EHR. The study included 1676 Chinese women with English-PL (50%) vs Chinese-PL (50%); 3453 Hispanic women with English-PL (72%) vs Spanish-PL (28%); and 20,289 non-Hispanic White (White) women with English-PL. Clinical conditions assessed included: current smoking; BMI <19 kg/m2; Charlson-Deyo Comorbidity Index (CCI); diabetes (DM) based on diagnosis with treatment; rheumatoid arthritis (RA) based on 2 diagnoses; and fracture diagnosis in the prior 5 years. Language subgroups (* denotes significant difference by PL, p<.05) and ethnic groups (all ethnic differences cited are significant at p<.05) were compared using chi-square tests. Results: Mean age was (69±3y) for Chinese, Hispanics, Whites, and PL subgroups. Prior fracture was lower in Chinese (12.8%) and Hispanics (25.6%) vs Whites (29.7%), with Chinese lower than Hispanics. Smoking was lower in Chinese (1.6%) and Hispanics (6.7%) vs Whites (11.3%). CCI score ≥3 was lower in Chinese (5.2%) and higher in Hispanics (13.0%) vs Whites (10.4%). RA was low overall and lowest in Chinese, especially Chinese-PL. More Chinese (4.2%) and fewer Hispanics (0.8%) had a BMI <19 vs Whites (2.2%). DM was higher in Hispanics (14.8%) and Chinese (8.2%) compared to Whites (5.7%). Significant and non-significant differences by PL were observed for current smoking (0.8%* vs 2.4% for Chinese-PL vs English-PL; 4.0% vs 7.8% for Spanish-PL vs English-PL), prior fracture (11.4%* vs 14.2% for Chinese-PL vs English-PL; 24.3% vs 26.1% for Spanish-PL vs English-PL) and DM (10.5%* vs 5.8% for Chinese-PL vs English-PL; 24.3% vs 26.1% for Spanish-PL vs English-PL) in Chinese and Hispanic women. Conclusion: Among older women initiating osteoporosis therapy, US Chinese women have lower comorbidity but a higher DM prevalence compared to white women, especially those with Chinese-PL. Hispanic women have higher comorbidity and higher DM prevalence than White women, with no differences by PL. Variation in prior fracture, low BMI, RA, and smoking were also seen. These findings highlight ethnic differences in women receiving osteoporosis care, including differences by primary language in Chinese women. Future studies should examine fracture risk factors and outcomes in US immigrant populations, especially Asians.