Article Figures & Data
Figures
- Figure 1.
Supply of chiropractic care (A) and primary care physicians (B) according to US hospital referral regions. Supply is based on the number of active practitioners per 10,000 capita and separated into quintiles.
- Figure 2.
Relationship between supply of chiropractic care and primary care physician (PCP) services according to US hospital referral regions.
Tables
- Table 1. Characteristics of Medicare Patients According to Whether They Visited a Primary Care Physician for Back and/or Neck Pain
No PCP Visit for Back and/or Neck Pain Visited any PCP for Back and/or Neck Pain Visited for Back and/or Neck Pain, By PCP Specialty Family Medicine PCP Internal Medicine PCP National estimates, n in millions Patients 14.7 3.0 1.4 1.7 Visits for back and/or neck pain 0.0 5.9 2.7 3.2 Estimated expenditures on back and/or neck pain* 0.0 1,345.2 615.6 729.6 Patient characteristics Mean age, years (SD) 76.4 (7.2) 76.6 (7.1) 76.1 (7.0) 77.0 (7.1) Sex, n in millions (%) Female 8.5 (57.7) 2.0 (65.1) 0.9 (64.1) 1.1 (66.2) Male 6.2 (42.3) 1.1 (34.9) 0.5 (35.9) 0.6 (33.8) Race, n in millions (%) Non-Hispanic white 13.1 (88.6) 2.7 (87.9) 1.3 (89.4) 1.5 (86.6) Non-Hispanic black 1.0 (6.8) 0.2 (6.4) 0.1 (5.5) 0.1 (7.0) Other 0.7 (4.6) 0.2 (5.6) 0.1 (5.0) 0.1 (6.3) Unknown 0.0 (0.1) 0.0 (0.1) 0.0 (0.1) 0.0 (0.1) Rurality of residence, n in millions (%) Urban 8.5 (57.9) 1.8 (59.1) 0.7 (50.2) 1.1 (66.6) Rural 3.8 (25.7) 0.8 (25.3) 0.5 (32.0) 0.3 (19.7) Unknown 2.4 (16.4) 0.5 (15.6) 0.3 (17.8) 0.2 (13.7) Charlson score, n in millions (%) 0 7.7 (52.0) 1.5 (49.1) 0.7 (50.6) 0.8 (47.6) 1 2.4 (16.5) 0.5 (16.7) 0.2 (16.7) 0.3 (16.7) 2 1.9 (12.8) 0.4 (13.9) 0.2 (13.4) 0.2 (14.4) ≥3 2.8 (18.7) 0.6 (20.3) 0.3 (19.3) 0.4 (21.4) Unknown 0.0 (0.0) 0.0 (0.0) 0.0 (0.0) 0.0 (0.0) All differences between those who did and did not visit any primary care physician (PCP) for back and/or neck pain are highly significant at P <.001; the t test was used to compare means and the χ2 test was used to compare proportions.
↵* Calculated by multiplying total visits by estimated cost per visit of $228.26
PCP, primary care physician; SD, standard deviation.
- Table 2. Adjusted Rate Ratios* (95% Confidence Intervals) for the Association between Quintile of Chiropractic Care Supply and Annual Number of Visits to Primary Care Physicians for Back and/or Neck Pain
Independent Variable Visits to any PCP for back and/or neck pain Visits for Back and/or Neck Pain, By PCP Specialty Family Medicine PCP Internal Medicine PCP Supply of health services Quintile of chiropractic care 1 (lowest) 1.00 (Reference) 1.00 (Reference) 1.00 (Reference) 2 1.08 (1.07–1.09) 1.07 (1.06–1.08) 1.08 (1.07–1.09) 3 0.98 (0.97–0.98) 0.97 (0.96–0.98) 0.94 (0.93–0.94) 4 0.97 (0.97–0.98) 0.86 (0.86–0.86) 1.02 (1.01–1.02) 5 (highest) 0.92 (0.91–0.92) 0.85 (0.84–0.86) 0.90 (0.89–0.91) PCP services,† number per 10,000 1.00 (1.00–1.00) 1.02 (1.02–1.02) 1.01 (1.01–1.01) Patient characteristics Age, years 1.00 (0.99–1.00) 0.99 (0.99–0.99) 1.01 (1.00–1.01) Sex Male 1.00 (Reference) 1.00 (Reference) 1.00 (Reference) Female 1.36 (1.35–1.36) 1.30 (1.30–1.31) 1.41 (1.40–1.41) Race/ethnicity Non-Hispanic white 1.00 (Reference) 1.00 (Reference) 1.00 (Reference) Other 1.11 (1.10,–1.11) 1.00 (0.99–1.00) 1.15 (1.14–1.16) Rurality of residence Urban 1.00 (Reference) 1.00 (Reference) 1.00 (Reference) Rural 0.99 (0.99–0.99) 1.39 (1.38–1.40) 0.72 (0.71–0.72) Charlson Comorbidity Score 0 1.00 (Reference) 1.00 (Reference) 1.00 (Reference) 1 1.13 (1.12–1.13) 1.10 (1.09–1.11) 1.15 (1.14–1.16) 2 1.25 (1.25–1.26) 1.20 (1.19–1.21) 1.30 (1.30–1.31) ≥3 1.29 (1.29–1.30 1.22 (1.21–1.24) 1.35 (1.34–1.35) For each of the 3 models, n = 14.9 million Medicare patients.
↵* All rate ratios are highly significant at P <.001 (except for race/ethnicity) in predicting visits to family medicine physicians.
↵† Variable used corresponds to primary care physician (PCP) specialty for the respective model (eg, for prediction of visits to family medicine PCPs, number of family medicine physicians per 10,000 capita was used).
- Table 3. Estimated National Impact of Chiropractic Care on Annual Total Primary Care Physician (PCP) Visits and Expenditures for Back and/or Neck Pain
Quintile of Chiropractic Care Supply With Chiropractic Care* Estimated Difference Without Chiropractic Care† Visits to PCPs for Back and/or Neck Pain Expenditures on PCP Visits for Back and/or Neck Pain Visits to PCPs for Back and/or Neck Pain Expenditures on PCP Visits for Back and/or Neck Pain 1 (Lowest) 1.21 275.6 Reference Reference 2 1.07 243.7 −0.14 −31.9 3 1.20 274.6 −0.01 −1.0 4 1.11 252.9 −0.10 −22.7 5 (Highest) 1.09 247.7 −0.12 −27.9 Total −0.37 −83.5
