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Journal of Integrative Medicine ›› 2023, Vol. 21 ›› Issue (2): 159-167.doi: 10.1016/j.joim.2023.02.002

• Systematic Review • Previous Articles     Next Articles

Disparities in chiropractic utilization by race, ethnicity and socioeconomic status: A scoping review of the literature

Jordan A. Gliedt a, Antoinette L. Spector b, Michael J. Schneider c,d, Joni Williams e, Staci Young f   

  1. a Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI 53226, USA
    b Department of Rehabilitation Sciences and Technology, University of Wisconsin-Milwaukee, Milwaukee, WI 53201, USA
    c Department of Physical Therapy, University of Pittsburgh, Pittsburgh, PA 15219, USA
    d Clinical and Translational Science Institute, University of Pittsburgh, Pittsburgh, PA 15213, USA
    e Department of Medicine, Division of Internal Medicine, Medical College of Wisconsin, Milwaukee, WI 53226, USA
    f Department of Family and Community Medicine, Medical College of Wisconsin, Milwaukee, WI 53226, USA
  • Received:2022-04-09 Accepted:2022-11-14 Online:2023-03-20 Published:2023-02-02

Chiropractic is the largest complementary and alternative medicine profession in the United States, with increasing global growth. A preliminary literature review suggests a lack of widespread diversity of chiropractic patient profiles.

There have been no prior studies to comprehensively integrate the literature on chiropractic utilization rates by race, ethnicity, and socioeconomic status. The purpose of this scoping review is to identify and describe the current state of knowledge of chiropractic utilization by race, ethnicity, education level, employment status, and income and poverty level.

Search strategy
Systematic searches were conducted in PubMed, Ovid MEDLINE, Cumulative Index of Nursing and Allied Health Literature (CINAHL), Cochrane Database of Systematic Reviews, and Index to Chiropractic Literature from inception to May 2021.

Inclusion criteria
Articles that reported race or ethnicity, education level, employment status, income or poverty level variables and chiropractic utilization rates for adults (≥18 years of age) were eligible for this review.

Data extraction and analysis
Data extracted from articles were citation information, patient characteristics, race and ethnicity, education level, employment status, income and poverty level, and chiropractic utilization rate. A descriptive numerical summary of included studies is provided. This study provides a qualitative thematic narrative of chiropractic utilization with attention to race and ethnicity, education level, income and poverty level, and employment status.

A total of 69 articles were eligible for review. Most articles were published since 2003 and reported data from study populations in the United States. Of the race, ethnicity and socioeconomic categories that were most commonly reported, chiropractic utilization was the highest for individuals identifying as European American/White/non-Hispanic White/Caucasian (median 20.00%; interquartile range 2.70%–64.60%), those with employment as a main income source (median utilization 78.50%; interquartile range 77.90%–79.10%), individuals with an individual or household/family annual income between $40,001 and $60,000 (median utilization 29.40%; interquartile range 25.15%–33.65%), and individuals with less than or equal to (12 years) high school diploma/general educational development certificate completion (median utilization 30.70%; interquartile range 15.10%–37.00%).

This comprehensive review of the literature on chiropractic utilization by race, ethnicity and socioeconomic status indicates differences in chiropractic utilization across diverse racial and ethnic and socioeconomic populations. Heterogeneity existed among definitions of key variables, including race, ethnicity, education level, employment status, and income and poverty level in the included studies, reducing clarity in rates of chiropractic utilization for these populations.

Key words: Chiropractic, Utilization, Health inequities, Health disparities, Low-back pain, Neck pain

[1] Hsueh-Hua Yang, Yu-Chu Chung, Pai-Pei Szeto, Mei-Ling Yeh, Jaung-Geng Lin. Laser acupuncture combined with auricular acupressure improves low-back pain and quality of life in nurses: A randomized controlled trial. Journal of Integrative Medicine, 2023, 21(1): 26-33.
[2] Xin Wang, Wen-juan Song, Yi Ruan, Bing-chu Li, Can Lü, Nian Huang, Fan-fu Fang, Wei Gu. Core muscle functional strength training for reducing the risk of low-back pain in military recruits: An open-label randomized controlled trial. Journal of Integrative Medicine, 2022, 20(2): 145-152.
[3] Arthur Yin Fan, Hui Ouyang, Xinru Qian, Hui Wei, David Dehui Wang, Deguang He, Haihe Tian, Changzhen Gong, Amy Matecki, Sarah Faggert Alemi. Discussions on real-world acupuncture treatments for chronic low-back pain in older adults. Journal of Integrative Medicine, 2019, 17(2): 71-76.
[4] Munmun Koley, Subhranil Saha, Jogendra Singh Arya, Gurudev Choubey, Shubhamoy Ghosh, Rajib Purkait, Ramkumar Mondal, Bapi Kundu, Rajarshi Mukherjee. A study on drug utilization and prescription habits of physicians in a government homeopathic hospital in West Bengal, India. Journal of Chinese Integrative Medicine, 2013, 11(5): 305-313.
[5] Zhi-xin Zheng, Jun Wang, Jing-shan Hou, Ling Ma, Cong-bo Jiang. A traditional Chinese medicine therapy warming meridians to nourish blood in treating chronic pain due to soft tissue injury of the neck and shoulder: A randomized controlled trial. Journal of Chinese Integrative Medicine, 2011, 9(2): 153-157.
[6] Xiao-qian Li, Jiao-na Yang, Yong-hua Su. Does the utilization of traditional Chinese herbs threaten the biodiversity?. Journal of Chinese Integrative Medicine, 2007, 5(4): 363-367.
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