Abstract
Introduction: It is presumed that as concentration of health care practitioners increases, health outcomes such as heart disease mortality rates (HDMR) decrease. This ecological study compares HDMRs with concentrations of: a) doctors of chiropractic (“DC ratios”) and medical doctors (“MD ratios”).Methods: The ratios were calculated by dividing total population in each state by total numbers of DCs and MDs in each state. The ratios were then compared to heart disease mortality rates using Pearson correlation and multiple linear regression. Results: DC ratios showed stronger associations with decreased HDMR compared to MD ratios. Discussion: Reasons for the stronger DC ratio associations are unclear. Two possible explanations are: a) dietary services that many DCs provide may not be provided generally by MDs, and b) spinal manipulation (also known as “adjustment”) may have, by way of neurological pathways, visceral benefits. Limitations to the study are its ecological design, where populations rather than individuals are studied. The study is intended only as a first step for further research.Conclusion: DC ratios showed stronger associations with decreased HDMR compared to MD ratios in this study. Further research with other designs, such as the case-control design is indicated. Since this is an observational study, causal inference is not claimed.
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