ACC RAC 2011 Award Winning Paper
Immunization Status of Adult Chiropractic Patients in Analyses of National Health Interview Survey

https://doi.org/10.1016/j.jmpt.2011.09.001Get rights and content

Abstract

Objective

Two recent studies that examined National Health Interview Survey data reported divergent findings regarding the propensity of adult chiropractic users to receive seasonal influenza immunization. Although one study found a statistically significant negative association between chiropractic use and influenza vaccination, another found that chiropractic users were significantly more likely to be vaccinated. The purpose of this study is to extend previous works by delving more deeply into recent data to identify adult chiropractic users at high risk and high priority for vaccination against influenza and pneumococcal disease.

Methods

We used data from the 2007 National Health Interview Survey in an attempt to replicate previous methodologies and further examine vaccination among adult chiropractic users (age ≥18 years) who, according to the Center for Disease Control and Prevention guidelines, should receive influenza and/or pneumococcal vaccination. We used complex survey design methods to make national estimates and used logistic regression to determine if having used chiropractic care predicted vaccination.

Results

We found major methodological differences between the prior studies. In our analyses, we found that chiropractic users were significantly less likely than nonusers to have received the pneumococcal vaccine, and we found no significant difference between chiropractic users and nonusers relative to having received the seasonal flu vaccine.

Conclusions

Methodological differences in previous studies that investigated the association between chiropractic care and adult vaccination likely explain divergent findings reported in the literature. Future studies should consider these differences.

Section snippets

Methods

This study was reviewed and was determined to be exempt from institutional board review by Dartmouth College's Committee for the Protection of Human Subjects.

Results

We were able to very nearly reproduce the findings of Jones et al7 that are reported in Table 1, using weighted data and adjusting for the complex sampling frame of the NHIS. Based on our replication of the Jones et al7 methods and analyses, we found that chiropractic users were significantly less likely than nonusers to have received the pneumococcal vaccine, and we found no significant difference between the 2 groups in having received both flu and pneumococcal vaccines (OR, 0.91; 95% CI,

Discussion

From our analyses, it is apparent that methodological differences likely account for the previous divergent findings from 2 prior analyses6, 7 that used NHIS data to look at the potential relationship between chiropractic care use and preventive vaccination (Table 1). The 2 studies6, 7 used different CDC criteria and different years of NHIS source data and differed in their selection of comparison groups, in their operationalization of covariate variables, and in their design of regression

Conclusion

We used the 2007 NHIS to further explore the relationship between having used chiropractic care and adult immunization, more specifically, adult influenza immunization. Our study finds that methodological differences vary widely in the literature among previous studies that have explored this relationship. These differences likely explain the divergent findings reported. In addition, the CDC's criteria used to identify adults that are “high priority” for immunization has changed considerably

Funding Sources and Potential Conflicts of Interests

Smith was supported by Award Number 1K01AT002391 from the National Center for Complementary and Alternative Medicine. Davis was supported by Award Number 1K01AT006162 from the National Center for Complementary and Alternative Medicine.

The views expressed herein do not necessarily represent the views of the National Center for Complementary and Alternative Medicine or the National Institutes of Health.

The authors reported no conflicts of interest.

Practical Applications

  • Methodological differences likely account for the

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  • Cited by (5)

    • Complementary medicine use and flu vaccination – A nationally representative survey of US adults

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      Regarding chiropractic consultations our data show that their users were less likely to receive flu vaccination as non-users. While Jones et al., 2010, presented comparable critical data [8], Smith et al., 2011, and Davis et al., 2012, [9,10] showed no negative coherence of chiropractic utilization. As Smith mentioned in their work, results can vary because of different methodological strategies.

    • Associations between complementary medicine utilization and influenza/pneumococcal vaccination: Results of a national cross-sectional survey of 9151 Australian women

      2017, Preventive Medicine
      Citation Excerpt :

      For example, analyses from NHIS data in the US has drawn contrasting results of the correlation between chiropractic use and the uptake of the influenza vaccine, showing chiropractic use as being correlated with both higher influenza vaccine use (Stokley et al., 2008) and lower vaccine use (Jones et al., 2010) in different studies. Re-analysis of this data by different authors has suggested these differences are dependent on the definition of chiropractic use is employed (i.e. ‘ever used’ versus ‘have used in past 12 months’) and how ‘high-priority’ conditions for vaccination were built into the multiple regression model (Smith and Davis, 2011). Additional re-analysis of this dataset also determined that for high-priority patients there were no significant differences in vaccination uptake between those patients who used chiropractic and those who did not use chiropractic (Davis et al., 2012).

    Research was conducted as Associate Professor, Palmer Center for Chiropractic Research, Palmer College of Chiropractic, San Jose, CA.

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