Evaluating Rates of Chiropractic Use and Utilization by Patient Sex within the United States Veterans Health Administration: A Serial Cross-Sectional Analysis

Abstract

Abstract Background Within the United States Veterans Health Administration (VHA), the number of patients using healthcare services has increased over the past several decades. Females make up a small proportion of overall patients within the VHA; however, this proportion is growing rapidly. Previous studies have described rates of VHA chiropractic use; however, no prior study assessed differences in use of utilization rates between male and female veterans. The purpose of this study was to assess rates of use and utilization of chiropractic care by sex among VHA patients receiving care at VHA facilities with on-station chiropractic clinics.Methods A serial cross-sectional analysis of VHA national electronic health record data was conducted in Fall 2021 for fiscal year (FY) 2005–2021. The cohort population was defined as VHA facilities with on-station chiropractic clinics, and facilities were admitted to the cohort after the first FY with a minimum of 500 on-station chiropractic encounters. Variables extracted included counts of unique users of any VHA on-station facility outpatient services, unique users of VHA on-station facility chiropractic services, number of chiropractic encounters, and by sex. Use was calculated as the rate of patients of each sex receiving chiropractic services out of total patients of the same sex within each facility, and utilization was calculated as the number of chiropractic care visits by patient per FY. Linear mixed effects models were applied to examine the difference in chiropractic care utilization by sex.Results The percentage of female VHA on-station chiropractic patients increased from 11.7–17.7% from FY2005–FY2021. Among VHA facilities with on-station chiropractic care, the percentage of female VHA healthcare users who used chiropractic care (mean = 2.3%) was greater than the percentage of male VHA healthcare users who used chiropractic care (mean = 1.1%). Rates of chiropractic utilization by sex among VHA facilities with on-station chiropractic clinics were similar between males (median = 4.1 visits per year, mean = 4.6) and females (median = 4.3 visits per year, mean = 4.9).Conclusion On-station VHA chiropractic services use was higher for female patients than their male counterparts, yet overall remains low. There were no differences in chiropractic utilization rates between sexes.