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

Spine (Phila Pa 1976). 1997 Oct 1;22(19):2254-63; discussion 2263-4. doi: 10.1097/00007632-199710010-00011.


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.

Publication types

  • Comparative Study
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Chiropractic / statistics & numerical data*
  • Comorbidity*
  • Cross-Sectional Studies
  • Female
  • Health Services / statistics & numerical data
  • Humans
  • Low Back Pain / rehabilitation*
  • Male
  • Middle Aged
  • Physicians / statistics & numerical data*