Chen Baojiang, Brown Henry S, Douphrate David, Janak Jud, Gabriel Kelley Pettee, Peng Trent
Department of Biostatistics, University of Texas Health Science Center at Houston, School of Public Health in Austin, Austin, Texas.
Department of Management, Policy and Community Health, University of Texas Health Science Center at Houston, School of Public Health in Austin, Austin, Texas.
J Manipulative Physiol Ther. 2024 Sep 28. doi: 10.1016/j.jmpt.2024.08.004.
This study aimed to evaluate the prospective associations of baseline personal characteristics with utilization frequency and expenditure of chiropractic care in US adults (≥18 years).
Data are from the 1358 respondents to the 2014 to 2016 Medical Expenditure Panel Survey who utilized chiropractic care. Individual, familial, health-related, and behavioral factors were included as covariates in the multivariate analytic model. Poisson and multinominal logistic regressions were modeled to examine the associations between the predictors and chiropractic utilization and expenditure.
The mean annual number of visits was 8.2 visits (95% confidence interval [CI]: 7.9, 8.5), with annual expenditure of $677.43 U.S. dollars (95% CI: $595.47-$759.39) and $84.84 (95% CI: $77.89-$91.78) per visit. Female sex was associated with a 19% higher number of visits (rate ratio [RR] = 1.19, 95% CI: 1.01, 1.41) than males. Publicly insured and uninsured were associated with a 44% higher (RR = 1.44, 95% CI: 1.14, 1.82) and 36% lower (RR = 0.64, 95% CI: 0.48, 0.86) visit frequency, respectively, than those privately insured. Rheumatoid arthritis was associated with 7.38 times the risk of high expenditure (95% CI: 2.61, 24.67) than medium expenditure, compared to no arthritis. Relative to physically active individuals, physical inactivity was associated with a 27% higher visit frequency (RR = 1.27, 95% CI: 1.09, 1.49) and an 82% higher risk (relative risk ratio = 1.82, 95% CI: 1.05, 3.14) of high expenditure than low expenditure.
This analysis found distinct usage and expenditure patterns that vary according to specific baseline predictors. Female sex, being publicly insured, having rheumatoid arthritis, and physically inactive were associated with variance in expenditure. Results from this study may help identify chiropractic patients with tendencies for higher utilization or spending and may indirectly assist in predicting patients with slower response to care.
本研究旨在评估美国成年人（≥18岁）的基线个人特征与整脊治疗使用频率和费用之间的前瞻性关联。
数据来自2014年至2016年医疗支出面板调查中1358名使用过整脊治疗的受访者。个体、家庭、健康相关和行为因素作为协变量纳入多变量分析模型。采用泊松回归和多项逻辑回归模型来检验预测因素与整脊治疗使用及费用之间的关联。
年平均就诊次数为8.2次（95%置信区间[CI]：7.9，8.5），年支出为677.43美元（95%CI：595.47 - 759.39美元），每次就诊费用为84.84美元（95%CI：77.89 - 91.78美元）。女性的就诊次数比男性多19%（率比[RR]=1.19，95%CI：1.01，1.41）。与参加私人保险的人相比，参加公共保险的人和未参保的人就诊频率分别高44%（RR = 1.44，95%CI：1.14，1.82）和低36%（RR = 0.64，95%CI：0.48，0.86）。与无关节炎的人相比，类风湿性关节炎患者高费用风险是中等费用风险的7.38倍（95%CI：2.61，24.67）。相对于身体活跃的个体，身体不活动的个体就诊频率高27%（RR = 1.27，95%CI：1.09，1.49），高费用风险比低费用风险高82%（相对风险比 = 1.82，95%CI：1.05，3.14）。
本分析发现了根据特定基线预测因素而有所不同的使用和费用模式。女性、参加公共保险、患有类风湿性关节炎以及身体不活动与费用差异相关。本研究结果可能有助于识别整脊治疗使用频率较高或费用较高的患者，并可能间接有助于预测对治疗反应较慢的患者。
