title: Chiropractic use by urban and rural residents with insurance coverage.
abstract: OBJECTIVE
  To describe the use of chiropractic care by urban and rural residents in Washington state with musculoskeletal diagnoses, all of whom have insurance coverage for this care. The analyses investigate whether restricting the analyses to insured individuals attenuates previously reported differences in the prevalence of chiropractic use between urban and rural residents as well as whether differences in provider availability or patient cost-sharing explain the difference in utilization.
  
  
  METHODS
  Claims data from 237,500 claimants in 2 large insurance companies in Washington state for calendar year 2002 were analyzed, using adjusted clinical group risk adjustment for differences in disease burden and rural urban commuting area codes for rurality definition.
  
  
  RESULTS
  The proportion of claimants using chiropractors was higher in rural than urban residents (44% vs 32%, P < .001). Lack of conventional providers in rural areas did not completely explain this difference, nor did differences in patient cost-sharing or demographics. Among those who used chiropractors, those in urban areas had more chiropractic visits than users of chiropractic in rural areas.
  
  
  CONCLUSIONS
  Among insured adults, use of chiropractic care was higher in rural than in urban areas. Reasons suggested for this difference in previous reports were not borne out in this data set.
authors: Department of Health Services, University of Washington, Seattle, Washington, USA. bonnielind@boisestate.edu
authors: Bonnie K
authors: BK
authors: Lind
authors: Paula K
authors: PK
authors: Diehr
authors: David E
authors: DE
authors: Grembowski
authors: William E
authors: WE
authors: Lafferty
mesh_terms: D000293:Adolescent; D000328:Adult; D005260:Female; D006801:Humans; D007345:Insurance Claim Review; D019458:Insurance Coverage; D007348:Insurance, Health; D008297:Male; D026882:Manipulation, Chiropractic / Q000706:statistics & numerical data*; D008875:Middle Aged; D012424:Rural Population; D014505:Urban Population; D014861:Washington; D055815:Young Adult