Spine. 1997 Oct; 22(19): 2254-63; discussion 2263-4.

The effects of comorbidity and other factors on medical versus chiropractic care for back problems.

Hurwitz EL, Morgenstern H.

Department of Epidemiology, School of Public Health, University of California-Los Angeles 90095-1772, USA.

STUDY DESIGN: This study is a cross-sectional analysis of adults in the United States who reported at least one back-related visit to a health care professional during a 2-week reference period. OBJECTIVES: To estimate and compare the effects of comorbidity and other factors on self-reported use of medical and chiropractic care for back problems in the United States. SUMMARY OF BACKGROUND DATA: Although back pain is the second most frequent primary symptom reported by patients seeking medical care and the most frequent primary symptom among chiropractic patients, there is a dearth of research on the predictors of chiropractic and medical care among back pain patients. METHODS: Data from the 1989 National Health Interview Survey were used to perform a cross-sectional analysis of adults who sought care for a back-related condition. The primary predictor variables included comorbidity and associated disability, sociodemographic variables, and back-problem-related variables. Weighted logistic regression modeling was performed to estimate odds ratios adjusted for the effects of covariates. RESULTS: Of the 4790 adults with reported back problems, 931 sought health care for their back condition during the 2-week reference period. Adults with disabling comorbidities and back-related restricted-activity days were relatively less likely to use chiropractic care than primary medical care. Those who were male, high-school educated, single, employed, and with more than nine doctor visits during the previous 12 months were relatively more likely to use chiropractic care than primary medical care. CONCLUSIONS: The presence of comorbidity-related or back-related disability, as well as other factors, affect the type of care sought for back conditions among adults in the United States.