Gliedt Jordan A, Spector Antoinette L, Schneider Michael J, Williams Joni, Young Staci
Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI 53226, USA.
Department of Rehabilitation Sciences and Technology, University of Wisconsin-Milwaukee, Milwaukee, WI 53201, USA.
J Integr Med. 2023 Mar;21(2):159-167. doi: 10.1016/j.joim.2023.02.002. Epub 2023 Feb 17.
Chiropractic is the largest complementary and alternative medicine profession in the United States, with increasing global growth. A preliminary literature review suggests a lack of widespread diversity of chiropractic patient profiles.
There have been no prior studies to comprehensively integrate the literature on chiropractic utilization rates by race, ethnicity, and socioeconomic status. The purpose of this scoping review is to identify and describe the current state of knowledge of chiropractic utilization by race, ethnicity, education level, employment status, and income and poverty level.
Systematic searches were conducted in PubMed, Ovid MEDLINE, Cumulative Index of Nursing and Allied Health Literature (CINAHL), Cochrane Database of Systematic Reviews, and Index to Chiropractic Literature from inception to May 2021.
Articles that reported race or ethnicity, education level, employment status, income or poverty level variables and chiropractic utilization rates for adults (≥18 years of age) were eligible for this review.
Data extracted from articles were citation information, patient characteristics, race and ethnicity, education level, employment status, income and poverty level, and chiropractic utilization rate. A descriptive numerical summary of included studies is provided. This study provides a qualitative thematic narrative of chiropractic utilization with attention to race and ethnicity, education level, income and poverty level, and employment status.
A total of 69 articles were eligible for review. Most articles were published since 2003 and reported data from study populations in the United States. Of the race, ethnicity and socioeconomic categories that were most commonly reported, chiropractic utilization was the highest for individuals identifying as European American/White/non-Hispanic White/Caucasian (median 20.00%; interquartile range 2.70%-64.60%), those with employment as a main income source (median utilization 78.50%; interquartile range 77.90%-79.10%), individuals with an individual or household/family annual income between $40,001 and $60,000 (median utilization 29.40%; interquartile range 25.15%-33.65%), and individuals with less than or equal to (12 years) high school diploma/general educational development certificate completion (median utilization 30.70%; interquartile range 15.10%-37.00%).
This comprehensive review of the literature on chiropractic utilization by race, ethnicity and socioeconomic status indicates differences in chiropractic utilization across diverse racial and ethnic and socioeconomic populations. Heterogeneity existed among definitions of key variables, including race, ethnicity, education level, employment status, and income and poverty level in the included studies, reducing clarity in rates of chiropractic utilization for these populations. Please cite this article as: Gliedt JA, Spector AL, Schneider MJ, Williams J, Young S. Disparities in chiropractic utilization by race, ethnicity and socioeconomic status: A scoping review of the literature. J Integr Med. 2023; 21(2): 159-167.
整脊疗法是美国最大的补充和替代医学专业，且在全球范围内的发展日益壮大。初步文献综述表明，整脊疗法患者的特征缺乏广泛的多样性。
此前尚无研究全面整合有关按种族、民族和社会经济地位划分的整脊疗法使用率的文献。本范围综述的目的是识别并描述按种族、民族、教育水平、就业状况、收入以及收入与贫困水平划分的整脊疗法使用情况的当前知识状态。
在PubMed、Ovid MEDLINE、护理及相关健康文献累积索引（CINAHL）、Cochrane系统评价数据库以及整脊文献索引中进行了从创刊至2021年5月的系统检索。
报告了种族或民族、教育水平、就业状况、收入或贫困水平变量以及成人（≥18岁）整脊疗法使用率的文章符合本综述的要求。
从文章中提取的数据包括引用信息、患者特征、种族和民族、教育水平、就业状况、收入和贫困水平以及整脊疗法使用率。提供了纳入研究的描述性数值摘要。本研究提供了关于整脊疗法使用情况的定性主题叙述，重点关注种族和民族、教育水平、收入和贫困水平以及就业状况。
共有69篇文章符合综述要求。大多数文章自2003年以来发表，并报告了来自美国研究人群的数据。在最常报告的种族、民族和社会经济类别中，自我认定为欧美裔/白人/非西班牙裔白人/高加索人的个体整脊疗法使用率最高（中位数20.00%；四分位间距2.70%-64.60%），以就业为主要收入来源的个体（使用率中位数78.50%；四分位间距77.90%-79.10%），个人或家庭/家庭年收入在40,001美元至60,000美元之间的个体（使用率中位数29.40%；四分位间距25.15%-33.65%），以及高中文凭/普通教育发展证书完成年限小于或等于12年的个体（使用率中位数30.70%；四分位间距15.10%-37.00%）。
这项关于按种族、民族和社会经济地位划分的整脊疗法使用情况的全面文献综述表明，不同种族、民族和社会经济人群在整脊疗法使用方面存在差异。纳入研究中关键变量的定义存在异质性，包括种族、民族、教育水平、就业状况以及收入和贫困水平，这降低了这些人群整脊疗法使用率的清晰度。请将本文引用为：Gliedt JA, Spector AL, Schneider MJ, Williams J, Young S. 按种族、民族和社会经济地位划分的整脊疗法使用差异：文献的范围综述。《整合医学杂志》。2023；21(2)：159-167。
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