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Health Care Affordability and Complementary and Alternative Medicine Utilization by Adults with Diabetes

¹ Department of Economics and Finance, University of Texas-Pan American, Edinburg, Texas
² Department of Computer Information Systems and Quantitative Methods, University of Texas-Pan American, Edinburg, Texas

Address correspondence and reprint requests to José A. Pagán, Economics and Finance, University of Texas-Pan American, 1201 West University Dr., Edinburg, TX 78539-2999. E-mail: jpagan{at}utpa.edu

Abbreviations: CAM, complementary and alternative medicine • NHIS, National Health Interview Survey

	INTRODUCTION

TOP INTRODUCTION RESEARCH DESIGN AND METHODS-- RESULTS-- CONCLUSIONS-- References

 
The use of complementary and alternative medicine (CAM) has been growing rapidly in the U.S. in recent years. The proportion of adults reporting the use of at least one CAM therapy during the previous year increased from 33.8% in 1990 to 42.1% in 1997 (1). Data from the 2002 National Health Interview Survey (NHIS) revealed that close to two-thirds of U.S. adults had used at least one CAM therapy during the previous year (2). A recent study using 2002 NHIS data showed that about one-half of all adults with diabetes were CAM users (3).

The main reasons for the rising popularity of CAM range from the actual/perceived inadequacies of conventional treatments to the desire for more autonomy in treatment decisions (3,4). Interestingly, CAM use is rising while at the same time conventional medicine has become less affordable (5). The purpose of this study is to analyze the relation between the affordability of conventional health care and the use of CAM by adults with diabetes.

	RESEARCH DESIGN AND METHODS—

TOP INTRODUCTION RESEARCH DESIGN AND METHODS-- RESULTS-- CONCLUSIONS-- References

 
The 2002 NHIS is a nationally representative survey of the civilian noninstitutionalized U.S. population. The survey includes demographic, socioeconomic, health, and health care utilization information on a sample of 31,044 adults. The 2002 NHIS included a CAM supplement with detailed information on the use of 17 CAM therapies (6). Our final sample included 2,142 adults who had been told by a doctor or other health care professional that they had diabetes. We focused on the use of at least 1 CAM therapy and on the individual use of 10 different CAM modalities. We only studied CAM modalities used by at least 1% of adults with diabetes in the sample (i.e., prayer and spiritual healing, herbal treatments, relaxation, chiropractic care, yoga/tai chi/qigong, massage, special diets, megavitamins, homeopathy, and acupuncture).

We created a dichotomous variable to capture whether respondents delayed or did not get needed conventional medical care because of cost (i.e., answering yes to one or both of these questions: "During the past 12 months, has medical care been delayed for [person] because of worry about the cost?" and "During the past 12 months, was there any time when [person] needed medical care, but did not get it because [person] couldn't afford it?") (7). We then used Pearson ² tests to analyze whether there were differences in CAM utilization that were related to delaying or not getting needed medical care because of cost.

For each CAM modality, we also estimated the average marginal effect of conventional health care access difficulties on CAM utilization based on a logistic regression adjusted for health insurance coverage status, education, age, sex, marital status, self-reported health status, ethnicity/race, and family income (8). All of the estimations were carried out using Stata, version 9.2, taking into account the complex survey design of the 2002 NHIS (9).

	RESULTS—

TOP INTRODUCTION RESEARCH DESIGN AND METHODS-- RESULTS-- CONCLUSIONS-- References

 
Table 1 shows that 70.48% of adults with diabetes used at least one CAM modality within the past year. CAM utilization rates were particularly high for prayer (61.34%), herbal treatments (15.09%), relaxation techniques (11.79%), and chiropractic care (6.57%). Except for megavitamins, CAM utilization rates were higher for adults with diabetes that delayed or did not get needed medical care because of cost than for those reporting no delays. The differences in CAM utilization rates associated with delays in getting conventional medical care were statistically significant for the use of at least one CAM modality (77.04 vs. 69.44%): prayer (70.56 vs. 59.89%), herbal treatments (19.86 vs. 14.34%), relaxation techniques (18.69 vs. 10.70%), and acupuncture (2.97 vs. 1.07%).

	CONCLUSIONS—

TOP INTRODUCTION RESEARCH DESIGN AND METHODS-- RESULTS-- CONCLUSIONS-- References

 
We found that adults with diabetes who delayed or did not get needed conventional medical care because of cost were more likely to report the use of at least one CAM modality within the past year compared with those reporting no cost-related difficulties in receiving care. These differences were present for 9 of 10 studied CAM therapies, and they were particularly important for prayer, herbal treatments, and relaxation techniques.

The results presented here suggest that when conventional health care becomes unaffordable, adults with diabetes resort to CAM to meet their unmet health care needs. An interesting finding is that education was positively related to the use of most CAM modalities. This suggests that CAM may be an integral component of diabetes management for those with better adherence to treatment regimes (10). Close to 89% of CAM users with diabetes reported that CAM had been important in maintaining their health compared with 79% of CAM users without diabetes. Approximately 52% of CAM users with diabetes had told their doctors about their use of CAM compared with 39% of CAM users without diabetes.

Several years of rising health care costs are likely to have forced many adults with diabetes to either delay or postpone health care or to resort to CAM (5). This should be a cause for concern because the clinical effectiveness of many CAM therapies favored by people with diabetes have not been fully established (11). Diabetes is a chronic health condition that requires careful management and appropriate access to the health care system to prevent related complications (12). As the use of CAM continues to grow because of rising costs, it is important that physicians are aware about the use of CAM by their patients to avoid potential risks.

	Acknowledgments

 
This publication was made possible by grants R21 AT002857-01A1 and 3 R21 AT002857-01A1S1 from the National Center for Complementary and Alternative Medicine, National Institutes of Health.

	Footnotes

 
Published ahead of print at http://care.diabetesjournals.org on 22 May 2007. DOI: 10.2337/dc07-0433.

The contents of this study are solely the responsibility of the authors and do not necessarily represent the official views of the National Center for Complementary and Alternative Medicine, National Institutes of Health.

A table elsewhere in this issue shows conventional and Système International (SI) units and conversion factors for many substances.

The costs of publication of this article were defrayed in part by the payment of page charges. This article must therefore be hereby marked "advertisement" in accordance with 18 U.S.C Section 1734 solely to indicate this fact.

Received for publication March 3, 2007. Accepted for publication May 13, 2007.

	References

TOP INTRODUCTION RESEARCH DESIGN AND METHODS-- RESULTS-- CONCLUSIONS-- References

 

1. Eisenberg DM, Davis RB, Ettner SL, Appel S, Wilkey S, Van Rompay M, Kessler RC: Trends in alternative medicine use in the United States, 1990–1997: results of a follow-up national survey. JAMA 280:1569–1575, 1998[Abstract/Free Full Text]
   
2. Barnes PM, Powell-Griner E, McFann K, Nahin RL: Complementary and alternative medicine use among adults: United States, 2002. In Advance Data from Vital and Health Statistics. Hyattsville, MD, National Center for Health Statistics, 2004, no. 343
   
3. Garrow D, Egede LE: Association between complementary and alternative medicine use, preventive care practices, and use of conventional services among adults with diabetes. Diabetes Care 29:15–19, 2006[Abstract/Free Full Text]
   
4. Dham S, Shah V, Hirsch S, Banerji MA: The role of complementary and alternative medicine in diabetes. Curr Diab Rep 6:251–258, 2006[Medline]
   
5. Catlin A, Cowan C, Heffler S, Washington B: National health spending in 2005: the slowdown continues. Health Aff (Millwood) 26:142–153, 2007[Abstract/Free Full Text]
   
6. National Center for Health Statistics: Data File Documentation, National Health Interview Survey, 2002. Hyattsville, MD, National Center for Health Statistics, 2003
   
7. Pagán JA, Pauly MV: Access to conventional medical care and the use of complementary and alternative medicine. Health Aff (Millwood) 24:255–262, 2005[Abstract/Free Full Text]
   
8. Cameron AC, Trivedi PK: Microeconometrics: Methods and Applications. New York, Cambridge University Press, 2005
   
9. StataCorp: Survey Data Reference Manual: Release 9. College Station, TX, Stata Press, 2005
   
10. Goldman DP, Smith JP: Can patient self-management help explain the SES health gradient? Proc Natl Acad Sci U S A 99:10929–10934, 2002[Abstract/Free Full Text]
    
11. Institute of Medicine Committee on the Use of Complementary and Alternative Medicine by the American Public: Complementary and Alternative Medicine in the United States. Washington, DC, The National Academies Press, 2005
    
12. American Diabetes Association: Standards of medical care in diabetes (Position Statement). Diabetes Care 27 (Suppl. 1):S15–S35, 2004.
    

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This Article Extract Full Text (PDF) All Versions of this Article: dc07-0433v1 30/8/2030    most recent Purchase Article View Shopping Cart Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Pagán, J. A. Articles by Tanguma, J. Search for Related Content PubMed PubMed Citation Articles by Pagán, J. A. Articles by Tanguma, J. Social Bookmarking                What's this?