Results of the “2023 F4CP Harris Poll on Consumer Adoption of Chiropractic Care”
The Foundation for Chiropractic Progress (F4CP), a not-for-profit organization dedicated to educating the public about the value of chiropractic care, announced the results of a new Harris Poll during September, National Drug-Free Pain Management Awareness Month, showing strong adoption of chiropractic care among younger Americans.
On behalf of F4CP, Harris Poll asked more than 2,000 American adults ages 18+ about the types of providers they seek to manage low back pain (LBP), barriers to adopting chiropractic, as well as their health insurance status. Given that chiropractic care is guideline concordant for LBP, and has been shown to help patients avoid opioids, F4CP’s goal was to obtain insights into why individuals choose different types of care.
Overall, 87% of poll respondents reported ever experiencing LBP. This is in line with independent studies that show that more than 80% of the population will experience an episode of LBP at some time during their lives.
Fortunately, 28% of Americans aged 54 and younger chose natural, drug-free chiropractic care to manage LBP. For pain relief, middle-aged and younger Americans, both insured and uninsured, are more likely to choose chiropractors compared to the national 25% average among all age groups, ranking second to allopathic and osteopathic primary care doctors (40%).
“In the spirit of National Drug-Free Pain Management Awareness Month, we are highly encouraged to report that so many younger Americans access safe, natural and drug-free chiropractic care to manage their low back pain,” said Sherry McAllister, DC, president of F4CP. “They grew up during the height of the opioid crisis and witnessed how painkiller prescriptions wrought devastation on individuals, families and communities. We are hopeful that this adoption level indicates a greater awareness of how neuromusculoskeletal pain is best managed through a holistic, non-pharmacologic care pathway focused on overall health and well-being.”
While it is encouraging to see 25-30% of individuals with LBP choose chiropractic care, this leaves 70-75% of individuals choosing a path resulting in a greater probability of being exposed to prescription opioids and unnecessary imaging and other low-value services. Prevailing medical guidelines recommend doctors manage new cases of acute LBP without drugs using methods such as spinal manipulation, heat, exercise, massage, and other treatments before drugs.
Through their adjustments and other procedures, chiropractors deliver guideline-concordant care and do not prescribe drugs, both of which are associated with a lower risk of patients receiving opioids for their LBP. Receiving care first from an allopathic or osteopathic doctor, however, is associated with greater odds of receiving an opioid prescription. From 1999 to 2020, more than 564,000 Americans died from an opioid overdose, according to the CDC.
Perhaps because of the wide public awareness of the drug’s risks, chiropractic care appears to be more popular among Americans ages 35 to 44, with 32% choosing to visit a DC. While 26% of Americans ages 18 to 34 noted in the survey they received chiropractic care, 33% chose prescribing primary care doctors. The youngest were also more likely than older age groups to seek physical therapy (18-34, 24% and 35-44, 25% vs. 55-64, 15% and 65+,16%).
Poll Results Mirror New Research
The new Harris Poll results mirror in-depth health insurance claims research recently submitted for publication in peer-reviewed scientific journals. For example, in a 2022 pre-print study, researchers reviewing a database of more than 616,000 insured adults with low back pain found that allopathic or osteopathic primary care doctors were contacted first in 36% of cases while DCs were contacted first by 31% of patients, which is similar to Harris Poll results (42% vs. 26% of insured respondents).
In another claims analysis submitted for publication in 2022, researchers found individuals who visited a DC for their LBP were more likely to live in affluent zip codes and to have access to more care options. Socioeconomic-disadvantaged individuals, however, tended to have fewer care choices and were more likely to visit an emergency department or receive a prescription painkiller for their LBP.
Likewise, poll results showed that 29% of participants earning $100,000 or more per year visited a DC, compared to 19% of participants earning $50,000 or less. Higher levels of post-secondary education and homeownership were also more often associated with receiving chiropractic care.
A similar study submitted for publication in June 2023 found that, like the Harris Poll results, women received care from DCs less often than men, but were more likely to visit other non-prescribing providers, such as physical therapists and acupuncturists. The results of the Harris Poll likewise showed that nearly a quarter of women visit a DC (24% vs. 26%), but that women age 44 and younger are just as likely to access chiropractic care as their male counterparts.
Insurance Influences Access
According to results, health insurance benefits may have influenced the type of care respondents chose. Overall, 94% of respondents had some type of benefits, either through an employer (45%), Medicare/Medicaid (36%) or purchased individually (13%).
For those with insurance coverage, 21% of commercially insured and 22% of Medicare beneficiaries reported that health plan benefit restrictions were a barrier to obtaining chiropractic care.
Benefits vary widely between commercial insurers and Medicare Advantage (MA) plans, which typically include traditional Medicare benefits plus additional services from a commercial health insurer. Unfortunately, MA members appear to access chiropractic care less often, according to one of the earlier referenced pre-print studies, which showed that only 3% of women with such coverage visit a DC first for their LBP. For traditional Medicare alone, however, chiropractic care is only covered when deemed “medically necessary,” which likely excludes preventive or routine care.
Interestingly, uninsured poll respondents* are just as likely to have sought care from DCs (14%) as they did from primary care doctors (13%), a strong indication that they view chiropractic care as an affordable and effective way to manage their LBP.
*Caution: small base (<100); results are directional in nature
Other results from the Harris Poll include:
- Parenthood is associated with greater chiropractic care access than the national average, with 31% of parents reporting they have visited a DC compared to 22% of non-parents.
- Americans living in the Midwest region of the U.S. are more likely than those living in the Northeast to access chiropractic care (28% vs. 21%).
- While higher-income individuals are more likely than those who earn less than $50K to say they received chiropractic care, they were also the group who were more likely to access care from an orthopedic surgeon (15% compared to the national average of 10% and 6% for individuals earning less than $50,000 a year).
Implications of Survey Findings:
- 21% of respondents who haven’t sought chiropractic care for lower back pain have a misperception that the treatment might hurt. This concern may be influenced by a recent social media trend featuring videos of DCs performing chiropractic adjustments that elicit a cracking or popping sound from the patient’s back. DCs and chiropractic leaders need to educate the public that adjustments are not painful and that the sounds are only gas exchanged from the joints being adjusted. On its website, the Cleveland Clinic dispels the notion that an adjustment hurts.
- Nearly 1 in 5 (17%) women ages 18 to 34 said they would adopt chiropractic care if they could find a female provider. Historically, a majority of DCs were men. The profession, however, is rapidly diversifying with more women pursuing chiropractic training.
- For the ~75% of individuals with LBP choosing to seek treatment from a medical doctor, a referral to a DC could increase adherence to prevailing guidelines and reduce opioid risks. Adding DCs to medical doctors’ referral networks would, in turn, free their schedule so they can focus on patients with non-neuromusculoskeletal conditions.
“Despite the positive adoption trends occurring, we still have a significant opportunity for DCs to be the patient’s ‘front door’ to manage their low back pain, an important reminder during September, National Drug-Free Pain Management Awareness Month,” said Dr. McAllister. “By filling knowledge gaps and expanding care access in more parts of the country, more Americans of all ages can experience the improved physical and mental health outcomes associated with chiropractic care for generations to come.”
This survey was conducted online within the United States by The Harris Poll on behalf of the Foundation for Chiropractic Progress between May 16-18, 2023 among 2,068 U.S. adults ages 18+. The sampling precision of Harris online polls is measured by using a Bayesian credible interval. For this study, the sample data is accurate to within + 2.8 percentage points using a 95% confidence level. For complete survey methodology, including weighting variables and subgroup sample sizes, please contact email@example.com.
National Drug-Free Pain Management Awareness Month occurs every September to raise public awareness about the dangers of prescription and over-the-counter pain medications, as well as safe and effective first-line care approaches available.
Source: Foundation for Chiropractic Progress Press Release, “Harris Poll: Younger Americans More Likely to Adopt Chiropractic Care,” August 30, 2023