Background
Methods
Study design and participants
Measures
Statistical analysis
Results
Characteristics | Chronic Condition | ||||
---|---|---|---|---|---|
Overall Sample | Hypercholesterolemia | Hypertension | Diabetes | Obesity | |
n(%) | n(%) | n(%) | n(%) | n(%) | |
Age Group | |||||
< 35 | 1241(8.0) | 502(39.9) | 823(66.6) | 137(11.1) | 490(39.8) |
35–49 | 2946(18.8) | 1658(56.4) | 1860(63.1) | 516(17.5) | 1327(44.9) |
50–64 | 5479(35.5) | 3496(63.2) | 3966(72.5) | 1338(24.0) | 2287(41.7) |
> 64 | 5797(37.7) | 3833(66.0) | 4649(80.2) | 1537(26.3) | 1523(26.4) |
Sex | |||||
Male | 6964(44.9) | 4322(61.8) | 5045(72.5) | 1616(22.9) | 2503(35.9) |
Female | 8499(55.1) | 5167(60.5) | 6253(73.7) | 1912(22.3) | 3124(36.8) |
Race and Ethnicity | |||||
Non-Hispanic White | 11,663(75.6) | 7423(63.4) | 8212(70.5) | 2500(21.3) | 4186(35.8) |
Non-Hispanic Black/African American | 2746(17.6) | 1377(49.7) | 2341(85.6) | 762(27.5) | 1199(44.2) |
Alaska Natives/American Indians | 158(1.0) | 86(54.1) | 122(78.9) | 53(33.7) | 76(50.8) |
Non-Hispanic Other | 896(5.8) | 603(67.4) | 623(69.5) | 213(23.3) | 166(18.3) |
Education Level | |||||
Less than High School | 2890(18.5) | 1718(59.1) | 2291(79.6) | 858(29.5) | 1062(36.8) |
High School Graduate/Some College | 8877(57.5) | 5358(60.1) | 6589(74.3) | 2060(22.9) | 3445(38.7) |
College/Professional Graduate | 3696(24.0) | 2413(65.2) | 2418(65.4) | 610(16.7) | 1120(30.5) |
Marital Status | |||||
Married | 8131(52.7) | 5219(64.0) | 5606(68.9) | 1778(21.8) | 2996(37.0) |
Widowed/Divorced | 5114(33.1) | 3150(61.2) | 4052(79.4) | 1293(24.7) | 1682(32.7) |
Single/Never Married | 2218(14.2) | 1120(49.9) | 1640(74.3) | 457(20.5) | 949(42.8) |
Family Income | |||||
< $20,000 | 6696(43.2) | 3904(58.2) | 5322(79.6) | 1850(27.2) | 2566(38.2) |
$20,000–$34,999 | 2107(13.8) | 1312(62.0) | 1546(73.4) | 460(21.9) | 802(38.0) |
$35,000–$49,999 | 2306(14.9) | 1448(62.2) | 1597(69.4) | 473(21.0) | 839(36.6) |
$50,000–$74,999 | 3435(22.3) | 2256(65.3) | 2145(62.5) | 544(15.6) | 1173(34.2) |
$75,000+ | 919(5.8) | 569(61.7) | 688(75.4) | 201(21.3) | 247(26.9) |
Health Insurance Coverage | |||||
Yes | 13,742(88.8) | 8655(62.6) | 10,009(73.0) | 3198(23.0) | 4894(35.7) |
No | 1721(11.2) | 834(48.9) | 1289(74.7) | 330(19.3) | 733(42.2) |
Regular Source of Care | |||||
Yes | 14,174(91.6) | 8836(62.1) | 10,389(73.4) | 3353(23.4) | 5240(37.0) |
No | 1289(8.4) | 653(50.7) | 909(70.3) | 175(13.5) | 387(30.1) |
Geographic Region | |||||
Northeast | 2554(16.6) | 1610(62.4) | 1803(70.8) | 545(20.9) | 878(34.2) |
Midwest | 3206(20.8) | 1981(61.4) | 2320(72.2) | 694(21.3) | 1244(39.0) |
South | 5962(38.6) | 3581(59.9) | 4536(76.3 | 1478(24.8) | 2276(38.4) |
West | 3741(24.0) | 2317(61.9) | 2639(70.6) | 811(21.4) | 1229(32.5) |
Hypercholesterolemia | |||||
Yes | 9489(61.1) | – | 5853(61.8) | 2219(23.1) | 3390(35.8) |
No | 5974(38.9) | – | 5445(91.1) | 1309(21.8) | 2237(37.3) |
Hypertension | |||||
Yes | 11,298(73.2) | 5853(51.6) | – | 2591(22.7) | 4422(39.1) |
No | 4165(26.8) | 3636(87.1) | – | 937(22.4) | 1205(28.9) |
Diabetes | |||||
Yes | 3528(22.6) | 2219(62.4) | 2591(73.4) | – | 1722(48.9) |
No | 11,935(77.4) | 7270(60.7) | 8707(73.1) | – | 3905(32.8) |
Body Mass Index | |||||
< 18.5 (Underweight) | 782(5.1) | 451(57.8) | 579(73.5) | 178(23.0) | – |
18.5–24.9 (Normal) | 3618(23.6) | 2199(60.2) | 2461(68.0) | 502(13.9) | – |
25.0–29.9 (Overweight) | 5436(34.9) | 3449(63.2) | 3836(70.8) | 1126(20.4) | – |
30.0+ (Obese) | 5627(36.4) | 3390(60.1) | 4422(78.7) | 1722(30.4) | – |
Manipulative Methods | |||||
Yes | 3778(24.3) | 2492(65.7) | 2678(71.1) | 762(20.2) | 1425(38.0) |
No | 11,685(75.7) | 6997(59.6) | 8620(73.8) | 2766(23.4) | 4202(35.9) |
Mind-Body Interventions | |||||
Yes | 801(5.1) | 497(62.0) | 518(64.9) | 88(11.4) | 220(27.7) |
No | 14,662(94.9) | 8992(61.1) | 10,780(73.6) | 3440(23.2) | 5407(36.9) |
Biological Treatments | |||||
Yes | 42(0.3) | 24(58.7) | 32(76.2) | 7(15.9) | 11(27.0) |
No | 15,421(99.7) | 9465(61.1) | 11,266(73.2) | 3521(22.6) | 5616(36.4) |
Energy Therapies | |||||
Yes | 72(0.5) | 49(67.3) | 38(51.8) | 11(14.5) | 29(39.1) |
No | 15,391(99.5) | 9440(61.1) | 11,260(73.3) | 3517(22.6) | 5598(36.4) |
Alternative Systems | |||||
Yes | 592(3.8) | 395(66.9) | 394(66.6) | 97(16.5) | 204(34.8) |
No | 14,871(96.2) | 9094(60.9) | 10,904(73.4) | 3431(22.8) | 5423(36.5) |
Independent Variables | Overall CAM Use | CAM Use in Patients with 2 or More Chronic Conditions | Adjusted Odds of CAM Use | |||||
---|---|---|---|---|---|---|---|---|
Patients with 1 Chronic Condition | Patients with 2 or More Chronic Conditions | |||||||
n(%) | χ2, p-value | n(%) | χ2, p-value | aOR [95% CI] | p-value | aOR [95% CI] | p-value | |
Age Group | 6.69, p < 0.001 | 14.04, p = 0.003 | ||||||
< 35 (ref) | 349(28.3) | 156(26.9) | 1.00 | – | 1.00 | – | ||
35–49 | 887(29.9) | 473(27.7) | 1.12[0.89,1.39] | 0.331 | 1.04[0.83,1.30] | 0.729 | ||
50–64 | 1740(31.6) | 1108(31.0) | 1.07[0.86,1.32] | 0.548 | 1.21[0.98,1.49] | 0.083 | ||
> 64 | 1607(27.6) | 1042(27.4) | 0.94[0.75,1.18] | 0.529 | 1.10[0.88,1.37] | 0.417 | ||
Sex | 3.28, p = 0.071 | 2.29, p = 0.130 | ||||||
Male (ref) | 1999(28.7) | 1219(28.0) | 1.00 | – | 1.00 | – | ||
Female | 2584(30.2) | 1560(29.4) | 1.25[1.11,1.42] | < 0.001 | 1.29[1.17,1.42] | < 0.001 | ||
Race and Ethnicity | 79.11, p < 0.001 | 161.97, p < 0.001 | ||||||
Non-Hispanic White (ref) | 3857(32.9) | 2307(32.0) | 1.00 | – | 1.00 | – | ||
Non-Hispanic Black/African American | 460(16.4) | 320(17.2) | 0.46[0.37,0.56] | < 0.001 | 0.52[0.45,0.60] | < 0.001 | ||
Alaska Natives/American Indians | 39(25.2) | 24(22.4) | 0.98[0.52,1.85] | 0.949 | 0.64[0.40,1.02] | 0.058 | ||
Non-Hispanic Other | 227(25.6) | 128(25.8) | 0.61[0.47,0.78] | < 0.001 | 0.75[0.60,0.94] | 0.012 | ||
Education Level | 111.49, p < 0.001 | 132.62, p < 0.001 | ||||||
Less than High School (ref) | 533(18.8) | 369(19.1) | 1.00 | – | 1.00 | – | ||
High School Graduate/Some College | 2696(30.0) | 1694(29.6) | 1.80[1.48,2.19] | < 0.001 | 1.53[1.34,1.74] | < 0.001 | ||
College/Professional Graduate | 1354(36.5) | 716(35.3) | 2.12[1.70,2.65] | < 0.001 | 1.78[1.51,2.09] | < 0.001 | ||
Marital Status | 12.49, p < 0.001 | 16.36, p < 0.001 | ||||||
Married (ref) | 2550(31.2) | 1533(30.2) | 1.00 | – | 1.00 | – | ||
Widowed/Divorced | 1465(28.3) | 919(28.0) | 1.04[0.90,1.21] | 0.589 | 1.02[0.92,1.15] | 0.666 | ||
Single/Never Married | 568(25.9) | 327(24.8) | 0.96[0.79,1.16] | 0.681 | 0.92[0.79,1.07] | 0.291 | ||
Family Income | 38.48, p < 0.001 | 97.68, p < 0.001 | ||||||
< $20,000 (ref) | 1652(24.7) | 1097(24.6) | 1.00 | – | 1.00 | – | ||
$20,000–$34,999 | 613(29.0) | 367(27.3) | 1.12[0.93,1.36] | 0.245 | 0.98[0.85,1.14] | 0.838 | ||
$35,000–$49,999 | 801(34.3) | 483(34.3) | 1.21[1.00,1.46] | 0.044 | 1.30[1.12,1.50] | < 0.001 | ||
$50,000–$74,999 | 1255(36.2) | 675(35.1) | 1.21[1.01,1.46] | 0.040 | 1.25[1.08,1.44] | 0.003 | ||
$75,000+ | 262(28.6) | 157(29.1) | 1.01[0.78,1.32] | 0.931 | 1.14[0.93,1.41] | 0.208 | ||
Health Insurance Coverage | 4.31, p = 0.039 | 0.05, p = 0.816 | ||||||
Yes | 4107(29.8) | 2489(28.8) | 1.05[0.85,1.29] | 0.674 | 0.84[0.71,0.99] | 0.041 | ||
No (ref) | 476(27.2) | 290(28.4) | 1.00 | – | 1.00 | – | ||
Regular Source of Care | 9.36, p = 0.002 | 7.02, p = 0.008 | ||||||
Yes | 4256(29.9) | 2624(29.0) | 1.06[0.86,1.31] | 0.596 | 1.09[0.88,1.35] | 0.424 | ||
No (ref) | 327(25.3) | 155(24.1) | 1.00 | – | 1.00 | – | ||
Geographic Region | 33.08, p < 0.001 | 157.90, p < 0.001 | ||||||
Northeast (ref) | 702(27.3) | 389(25.0) | 1.00 | – | 1.00 | – | ||
Midwest | 1140(35.6) | 723(35.8) | 1.21[1.00,1.46] | 0.046 | 1.64[1.41,1.90] | < 0.001 | ||
South | 1441(24.1) | 895(23.1) | 0.91[0.76,1.08] | 0.268 | 1.03[0.89,1.19] | 0.681 | ||
West | 1300(34.4) | 772(34.6) | 1.21[1.01,1.45] | 0.037 | 1.61[1.38,1.87] | < 0.001 | ||
Hypercholesterolemia | 45.22, p < 0.001 | 13.64, p < 0.001 | ||||||
Yes | 2995(31.5) | 2105(29.7) | ||||||
No | 1588(26.4) | 674(25.9) | ||||||
Hypertension | 27.19, p < 0.001 | 0.33, p = 0.566 | ||||||
Yes | 3210(28.3) | 2357(28.6) | ||||||
No | 1373(32.7) | 422(29.4) | ||||||
Diabetes | 41.12, p < 0.001 | 25.62, p < 0.001 | ||||||
Yes | 877(25.0) | 814(25.4) | ||||||
No | 3706(30.8) | 1965(30.4) | ||||||
Body Mass Index | 12.01, p < 0.001 | 22.60, p < 0.001 | ||||||
< 18.5 (Underweight) | 158(1.0) | 67(19.8) | ||||||
18.5–24.9 (Normal) | 1092(7.0) | 338(25.6) | ||||||
25.0–29.9 (Overweight) | 1669(10.7) | 712(29.6) | ||||||
30.0+ (Obese) | 1664(10.8) | 1662(29.6) |
Disease Combinations | Overall CAM Use (n = 15,463) | CAM Modalities | ||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|
Manipulative Methods (n = 3778) | Biological Treatments (n = 42) | Mind-Body Interventions (n = 801) | Energy Therapies (n = 72) | Alternative Systems (n = 592) | ||||||||
(%) | χ2 value, p-value |
(%)
| χ2 value, p-value | (%) | χ2 value, p-value |
(%)
| χ2 value, p-value |
(%)
| χ2 value, p-value |
(%)
| χ2 value, p-value | |
Disease Dyads | ||||||||||||
ChoBp | 0.08, p = 0.773 | 5.12, p = 0.024 | 0.03, p = 0.872 | 30.13, p < 0.001 | 5.32, p = 0.022 | 1.02, p = 0.314 | ||||||
Yes | 11.2 | 25.4 | 0.3 | 3.9 | 0.3 | 3.6 | ||||||
No | 18.3 | 23.7 | 0.3 | 5.9 | 0.6 | 4.0 | ||||||
ChoDiab | 6.15, p = 0.014 | 0.58, p = 0.447 | 0.25, p = 0.614 | 29.25, p < 0.001 | 4.16, p = 0.042 | 2.83, p = 0.094 | ||||||
Yes | 3.8 | 23.7 | 0.2 | 2.6 | 0.2 | 3.1 | ||||||
No | 25.7 | 24.4 | 0.3 | 5.6 | 0.5 | 3.9 | ||||||
ChoOb | 10.53, p = 0.001 | 22.79, p < 0.001 | 1.27, p = 0.261 | 18.55, p < 0.001 | 2.64, p = 0.106 | 1.40, p = 0.238 | ||||||
Yes | 6.9 | 27.4 | 0.2 | 3.7 | 0.7 | 4.1 | ||||||
No | 22.6 | 23.5 | 0.3 | 5.6 | 0.4 | 3.7 | ||||||
BpDiab | 17.18, p < 0.001 | 4.51, p = 0.035 | 0.15, p = 0.702 | 37.98, p < 0.001 | 4.78, p = 0.030 | 4.88, p = 0.028 | ||||||
Yes | 4.3 | 22.7 | 0.2 | 2.6 | 0.2 | 3.0 | ||||||
No | 25.2 | 24.6 | 0.3 | 5.7 | 0.5 | 4.0 | ||||||
BpOb | 0.05, p = 0.827 | 2.61, p = 0.107 | 1.67, p = 0.197 | 14.34, p < 0.001 | 2.68, p = 0.103 | 3.03, p = 0.083 | ||||||
Yes | 8.4 | 25.1 | 0.2 | 4.0 | 0.3 | 3.4 | ||||||
No | 21.1 | 24.0 | 0.3 | 5.6 | 0.5 | 4.0 | ||||||
DiabOb | 8.55, p = 0.004 | 2.01, p = 0.157 | 5.69, p = 0.018 | 27.74, p < 0.001 | 1.56, p = 0.212 | 2.43, p = 0.120 | ||||||
Yes | 2.9 | 22.9 | 0.04 | 2.4 | 0.3 | 3.1 | ||||||
No | 26.6 | 24.5 | 0.3 | 5.5 | 0.5 | 3.9 | ||||||
Disease Triads | ||||||||||||
ChoBpDiab | 2.84, p = 0.093 | 0.04, p = 0.834 | 0.01, p = 0.933 | 22.67, p < 0.001 | 3.74, p = 0.054 | 1.08, p = 0.299 | ||||||
Yes | 3.20 | 24.1 | 0.3 | 2.6 | 0.2 | 3.3 | ||||||
No | 26.3 | 24.3 | 0.3 | 5.5 | 0.5 | 3.9 | ||||||
ChoBpOb | 5.13, p = 0.024 | 13.43, p < 0.001 | 2.68, p = 0.102 | 14.78, p < 0.001 | 0.42, p = 0.518 | 0.02, p = 0.884 | ||||||
Yes | 4.9 | 27.2 | 0.1 | 3.6 | 0.4 | 3.8 | ||||||
No | 24.6 | 23.8 | 0.3 | 5.4 | 0.5 | 3.8 | ||||||
ChoDiabOb | 0.37, p = 0.544 | 0.28, p = 0.596 | 2.82, p = 0.094 | 18.48, p < 0.001 | 1.30, p = 0.255 | 0.40, p = 0.528 | ||||||
Yes | 2.0 | 25.0 | 0.0 | 2.2 | 0.2 | 3.5 | ||||||
No | 27.5 | 24.3 | 0.3 | 5.4 | 0.5 | 3.8 | ||||||
BpDiabOb | 4.34, p = 0.038 | 0.48, p = 0.491 | 3.89, p = 0.050 | 18.99, p < 0.001 | 2.28, p = 0.132 | 1.04, p = 0.309 | ||||||
Yes | 2.3 | 23.5 | 0.1 | 2.5 | 0.2 | 3.3 | ||||||
No | 27.2 | 24.4 | 0.3 | 5.4 | 0.5 | 3.9 |
Sample characteristics
Bivariate and multivariate analysis of CAM use
Bivariate analysis
Multivariate analysis: Participants with one chronic condition
Multivariate analysis: Participants with two or more chronic conditions
Multivariate analysis: CAM use by disease dyads and triads
Disease Combinations | Adjusted Odds of CAM Use | |
---|---|---|
aOR [95% CI] | p-value | |
Disease Dyads | ||
ChoBp | ||
No (ref) | 1.04[0.95–1.14] | 0.351 |
Yes | 1.00 | – |
ChoDiab | ||
No (ref) | 0.92[0.75–1.11] | 0.368 |
Yes | 1.00 | – |
ChoOb | ||
No (ref) | 1.08[0.96–1.21] | 0.210 |
Yes | 1.00 | – |
BpDiab | ||
No (ref) | 1.06[0.91–1.24] | 0.451 |
Yes | 1.00 | – |
BpOb | ||
No (ref) | 1.05[0.96–1.15] | 0.309 |
Yes | 1.00 | – |
DiabOb | ||
No (ref) | 0.70[0.55–0.88] | 0.003 |
Yes | 1.00 | – |
Disease Triads | ||
ChoBpDiab | ||
No (ref) | 1.00 | – |
Yes | 1.11[0.94–1.32] | 0.210 |
ChoBpOb | ||
No (ref) | 1.00 | – |
Yes | 1.22[1.09–1.36] | 0.001 |
ChoDiabOb | ||
No (ref) | 1.00 | – |
Yes | 1.41[1.02–1.94] | 0.037 |
BpDiabOb | ||
No (ref) | 1.00 | – |
Yes | 0.83[0.67–1.03] | 0.083 |
Multivariate analysis: CAM domain use by disease status
Discussion
Limitations
Implications for family practitioners
MIND-BODY INTERVENTIONS | MANIPULATIVE METHODS | ||||
---|---|---|---|---|---|
Hypertension*** Diabetes*** Obesity*** | ChoBp*** ChoDiab*** ChoOb*** BpDiab*** BpOb*** DiabOb*** | ChoBpDiab*** ChoBpOb*** ChoDiabOb*** BpDiabOb*** | Hypercholesterolemia*** Hypertension** Diabetes*** Obesity* | ChoBp* ChoOb*** BpDiab* | ChoBpOb*** |
ALTERNATIVE SYSTEMS | ENERGY THERAPIES | ||||
Hypercholesterolemia** Hypertension*** Diabetes** | BpDiab* | Hypertension*** | ChoBp* ChoDiab* BpDiab* | ||
BIOLOGICAL TREATMENTS | |||||
DiabOb* |