A longitudinal study of chiropractic use among older adults in the United States

Abstract

BackgroundLongitudinal patterns of chiropractic use in the United States, particularly among Medicare beneficiaries, are not well documented. Using a nationally representative sample of older Medicare beneficiaries we describe the use of chiropractic over fifteen years, and classify chiropractic users by annual visit volume. We assess the characteristics that are associated with chiropractic use versus nonuse, as well as between different levels of use.MethodsWe analyzed data from two linked sources: the baseline (1993-1994) interview responses of 5,510 self-respondents in the Survey on Assets and Health Dynamics Among the Oldest Old (AHEAD), and their Medicare claims from 1993 to 2007. Binomial logistic regression was used to identify factors associated with chiropractic use versus nonuse, and conditional upon use, to identify factors associated with high volume relative to lower volume use.ResultsThere were 806 users of chiropractic in the AHEAD sample yielding a full period prevalence for 1993-2007 of 14.6%. Average annual prevalence between 1993 and 2007 was 4.8% with a range from 4.1% to 5.4%. Approximately 42% of the users consumed chiropractic services only in a single calendar year while 38% used chiropractic in three or more calendar years. Chiropractic users were more likely to be women, white, overweight, have pain, have multiple comorbid conditions, better self-rated health, access to transportation, higher physician utilization levels, live in the Midwest, and live in an area with fewer physicians per capita. Among chiropractic users, 16% had at least one year in which they exceeded Medicare's "soft cap" of 12 visits per calendar year. These over-the-cap users were more likely to have arthritis and mobility limitations, but were less likely to have a high school education. Additionally, these over-the-cap individuals accounted for 58% of total chiropractic claim volume. High volume users saw chiropractors the most among all types of providers, even more than family practice and internal medicine combined.ConclusionThere is substantial heterogeneity in the patterns of use of chiropractic services among older adults. In spite of the variability of use patterns, however, there are not many characteristics that distinguish high volume users from lower volume users. While high volume users accounted for a significant portion of claims, the enforcement of a hard cap on annual visits by Medicare would not significantly decrease overall claim volume. Further research to understand the factors causing high volume chiropractic utilization among older Americans is warranted to discern between patterns of "need" and patterns of "health maintenance".

The 2008 Prevalence of Chiropractic Use in the US Adult Population

“…These findings are consistent with a number of studies that have looked at these 2 geographic measures independently. 4,11,13,14,26 However, our results indicate that the chiropractic prevalence across the urban-rural continuum varies significantly depending on the region of the country. In the Northeast, individuals living in small metropolitan areas have the highest rates of use.…”

“…This estimate is considerably lower than estimates reported specifically for chiropractic use in the 1990s and is in line with a recent study looking at chiropractic use in the older US population. 1,2,5,11 We observed that the propensity to use these services varies by person-level sociodemographic and geographic characteristics and to a lesser extent by health characteristics. Race/ethnicity is a key demographic factor in characterizing the propensity for using chiropractic care.…”

“…8,9 Another study focusing specifically on chiropractic services in the Medicare population reported the average annual prevalence (1993)(1994)(1995)(1996)(1997)(1998)(1999)(2000)(2001)(2002)(2003)(2004)(2005)(2006)(2007) of chiropractic use among older adults to be 4.8% (range, 4.1%-5.4%). 11 Many of the published studies report rates of chiropractic use for multiple sociodemographic characteristics (eg, by sex, race and ethnicity, education, etc), but these rates pertain to complementary and alternative medicine (CAM) in general or to select groupings of CAM therapies, not chiropractic services specifically. 1,2,7,8 Other studies examine a more limited set of sociodemographic characteristics, select patient population subgroups (ie, older adults), and/or specific regional geographic areas.…”

Chiropractic Use in the Medicare Population: Prevalence, Patterns, and Associations With 1-Year Changes in Health and Satisfaction With Care

“…4,5 For younger Medicare beneficiaries chiropractic prevalence rates are closer to national rates, ranging between 6%–7%. 6 While informative, these estimates are not reflective of the population that commonly seeks care from doctors of chiropractic (DCs)—namely, persons seeking treatment for spine-related health conditions.…”

Attributes of Non-Hispanic Blacks That Use Chiropractic Health Care: A Survey of Patients in Texas and Louisiana

“…[2][3][4][5][6][7]9,15,16,[26][27][28][29] In many instances, whites used chiropractic at least twice as often as blacks. 2,4,6,7,9,15,16,26,29 Some have attributed this difference to the perception of discrepancies of health care treatment by blacks, lower average educational levels of blacks compared to whites, and the lack of accessibility to doctors of chiropractic (DCs) in black communities. 2,4,20,21,30 Very little information currently exists in the literature that describes use of chiropractic by non-Hispanic black patients.…”