The complementarity and substitution between unconventional and mainstream medicine among racial and ethnic groups in the United States

Health Serv Res. 2007 Apr;42(2):811-26. doi: 10.1111/j.1475-6773.2006.00628.x.


Objectives: To describe racial and ethnic differences in the utilization patterns of 12 common types of complementary and alternative medicine (CAM) and mainstream medicine (MSM) and to test whether a specific CAM type is a substitute for or a complement to MSM among five racial and ethnic groups in the United States.

Methods: The Medical Expenditure Panel Survey in 1996 and 1998 were used. The sample of 46,673 respondents was stratified into non-Hispanic whites (NHW), Hispanics, blacks, Asians, and other races. Twelve types of CAM visits and visits to office-based and outpatient physicians were used to describe the pattern of CAM and MSM use. Utilization patterns among each racial and ethnic group were established and compared. Multivariate analyses were conducted to test whether each type of CAM and MSM were complements or substitutes within a racial and ethnic group, controlling for respondents' sociodemographics and health.

Results: Significant intergroup differences in the prevalence rates of using various types of CAM were found. In particular, for some racial and ethnic groups, CAM can be either a substitute for or a complement to MSM visits, depending on the CAM type. More complementary relationships between CAM and physician visits were found in NHW and Asians than in other groups. All significant relationships between CAM types and physician visits among Hispanics and other races (predominantly Native American Indians) were substitution.

Conclusions: Complementarity and substitution of CAM and MSM varied by racial and ethnic groups and by type of CAM. Culturally sensitive approaches are needed in successful integration of CAM in treatment management.

MeSH terms

  • Complementary Therapies / statistics & numerical data*
  • Continental Population Groups*
  • Ethnic Groups*
  • Female
  • Health Services / statistics & numerical data*
  • Health Services Research
  • Health Status
  • Humans
  • Male
  • Middle Aged
  • Socioeconomic Factors
  • United States