Addressing Disparities in Chiropractic Care: A Look at Utilization Across Racial and Socioeconomic Groups
By Jordan A. Gliedt, Antoinette L. Spector, Michael J. Schneider, Joni Williams, and Staci Young
Published in: Journal of Integrative Medicine (2023)
Chiropractic care has become a primary approach for managing musculoskeletal pain, particularly spinal issues like low back and neck pain. However, while chiropractic services grow in popularity, they remain disproportionately utilized across racial, ethnic, and socioeconomic groups. This comprehensive scoping review addresses critical disparities in chiropractic utilization by examining factors such as race, ethnicity, education level, employment status, and income.
Key Findings
Disparities by Race and Ethnicity: Chiropractic care is predominantly utilized by European American/White populations. Utilization rates are significantly lower among African American, Hispanic, and Asian communities. This discrepancy raises questions about accessibility, awareness, and potential cultural barriers within these communities.
Socioeconomic Factors: The review highlights that individuals with higher education levels, stable employment, and higher incomes are more likely to utilize chiropractic care. By contrast, those with lower incomes or limited educational opportunities show reduced usage, suggesting that socioeconomic barriers significantly influence access to and engagement with chiropractic services.
Impact on Health Equity: These disparities reveal critical gaps in healthcare access, particularly in communities where spine pain and related conditions may be under-treated. Without equitable access to chiropractic care, health disparities could widen, affecting quality of life for underrepresented groups dealing with chronic pain and limited treatment options.
Detailed Summary
The review synthesized data from 69 studies, with most research conducted in the United States. Data from these studies reveal that chiropractic utilization is highest among individuals identifying as White, employed, and earning middle-to-high incomes. Specifically:
Race and Ethnicity: White, non-Hispanic individuals report the highest chiropractic usage (median 20%), while Hispanic individuals report the lowest (median 3.9%). The article suggests that cultural and awareness barriers, along with a predominantly White chiropractic workforce, may contribute to lower utilization rates in minority groups.
Education and Employment: Utilization is higher among individuals with at least some college education and those with stable, full-time employment. Employment status appears to be a strong predictor of chiropractic use, with unemployed individuals showing lower utilization rates.
Income Levels: Individuals within the income bracket of $40,001-$60,000 utilize chiropractic care more frequently, likely reflecting an ability to afford out-of-pocket costs for alternative healthcare services. Conversely, individuals in the lowest income brackets show the least engagement with chiropractic care.
Implications and Future Directions
This review underscores the need for improved accessibility and outreach in minority and low-income communities. The authors suggest several potential approaches to reduce disparities:
Culturally Competent Care: Chiropractic clinics can implement training to provide culturally sensitive care, potentially reducing barriers for non-White patients.
Community Outreach and Education: Increased education efforts within underrepresented communities could raise awareness of chiropractic care as a viable and effective pain management option.
Policy and Insurance Adjustments: Policies aimed at covering chiropractic care through Medicaid and other public insurance programs could increase accessibility for lower-income individuals who may otherwise struggle with the costs of treatment.
Conclusion
As chiropractic care continues to gain recognition as a non-pharmacological approach to pain management, addressing disparities in utilization becomes critical. Ensuring equitable access to chiropractic services will not only improve health outcomes but also support a more inclusive healthcare system. This scoping review provides essential insights into existing disparities and highlights the need for further research and targeted interventions to bridge gaps in chiropractic care utilization.
Full Article
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Citation
Gliedt, J. A., Spector, A. L., Schneider, M. J., Williams, J., & Young, S. (2023). Disparities in chiropractic utilization by race, ethnicity, and socioeconomic status: A scoping review of the literature. Journal of Integrative Medicine, 21(2), 159–167. https://doi.org/10.1016/j.joim.2023.02.002