A comparative analysis of chiropractic and general practitioner patients in North America: findings from the joint Canada/United States Survey of Health, 2002-03.

Eric L Hurwitz,Lu-May Chiang

doi:10.1186/1472-6963-6-49

Abstract

BackgroundScientifically rigorous general population-based studies comparing chiropractic with primary-care medical patients within and between countries have not been published. The objective of this study is to compare care seekers of doctors of chiropractic (DCs) and general practitioners (GPs) in the United States and Canada on a comprehensive set of sociodemographic, quality of life, and health-related variables.MethodsData are from the Joint Canada/U.S. Survey of Health (JCUSH), 2002–03, a random sample of adults in Canada (N = 3505) and the U.S. (N = 5183). Respondents were categorized according to their pattern of health-care use in the past year. Distributions, percentages, and estimates (adjusted odds ratios) weighted to reflect the complex survey design were produced.ResultsNearly 80% of respondents sought care from GPs; 12% sought DC care. Compared with GP only patients, DC patients in both countries tend to be under 65 and white, with arthritis and disabling back or neck pain. U.S. DC patients are more likely than GP only patients to be obese and to lack a regular doctor; Canadian DC patients are more likely than GP only patients to be college educated, to have higher incomes, and dissatisfied with MD care. Compared with seekers of both GP and DC care, DC only patients in both countries have fewer chronic conditions, take fewer drugs, and have no regular doctor. U.S. DC only patients are more likely than GP+DC patients to be uninsured and dissatisfied with health care; Canadian DC only patients are more likely than GP+DC patients to be under 45, male, less educated, smokers, and not obese, without disabling back or neck pain, on fewer drugs, and lacking a regular doctor.ConclusionChiropractic and GP patients are dissimilar in both Canada and the U.S., with key differences between countries and between DC patients who do and do not seek care from GPs. Such variation has broad and potentially far-reaching health policy and research implications.

Highlights

Rigorous general population-based studies comparing chiropractic with primary-care medical patients within and between countries have not been published
Little is known about the similarities and differences of persons who integrate chiropractic care with general medical care vs. those who consult chiropractors alone, either for musculoskeletal or neuromusculoskeletal problems, primary health care, disease prevention, or other reasons
Research findings show that greater than 50% of complementary or alternative medical (CAM) users seek such care because they believe that CAM combined with conventional medical care would be helpful, suggesting that CAM does not substitute for conventional care

Summary

Introduction

Rigorous general population-based studies comparing chiropractic with primary-care medical patients within and between countries have not been published. The majority of all health-provider visits for low-back pain are to chiropractors, with patients reporting high levels of satisfaction and helpfulness [4,5]. Little is known about the similarities and differences of persons who integrate chiropractic care with general medical care vs those who consult chiropractors alone, either for musculoskeletal or neuromusculoskeletal problems, primary health care, disease prevention, or other reasons. In recent studies of family practice and primary care patients, 20 to 30% report using some form of complementary or alternative medical (CAM) therapy, most commonly for back pain, other musculoskeletal pain, or for psychosocial problems or stress [6,7]. Three in 10 CAM users believe that conventional care alone would not be effective for their condition [3] and greater than six in 10 of CAM patients do not tell their physicians about their use of CAM [8,9] and users of both CAM and conventional care for back or neck problems perceived CAM as more helpful than conventional care [9]

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