title: Chiropractic use, health care expenditures, and health outcomes for rural and nonrural individuals with arthritis.
abstract: OBJECTIVE
  Arthritis is considered the leading cause of disability among adults in the United States today and contributes substantially to the rising cost of health care. Residents of rural areas are especially affected. The purposes of this article are to describe chiropractic use by rural and nonrural individuals with arthritis and to identify differences in other health care use and health status by those using chiropractic care plus conventional care or conventional care alone.
  
  
  METHODS
  A longitudinal cohort from panel 12 (N = 12440) of the Medical Expenditure Panel Survey spanning 2007 to 2008 was selected for this study to represent changes in health care expenditures and use and outcomes throughout this period. The population was stratified by self-reported physician-diagnosed arthritis and rural status and compared across demographics, health status, and health care use and expenditures, including use of chiropractic services plus conventional care or conventional care alone.
  
  
  RESULTS
  Twice as many rural people with arthritis had 1 or more visits with a doctor of chiropractic compared with nonrural persons with arthritis. More rural chiropractic users with arthritis reported their perceived health status as excellent, very good, or good compared with nonrural chiropractic users with arthritis and to rural people with arthritis who reported no chiropractic visits. Health care expenditures for other physician services were higher among rural chiropractic users with arthritis than nonrural users with arthritis.
  
  
  CONCLUSIONS
  Differences in chiropractic use were observed between rural and nonrural individuals with arthritis. More studies are needed to investigate these differences and the impact on health care use and expenditures and outcomes of individuals with arthritis.
authors.affiliation: Center for the Study of Complementary and Alternative Therapies, School of Nursing, University of Virginia, Charlottesville, VA 22908, USA. ee2fv@virginia.edu
authors.forename: Ekele I
authors.initials: EI
authors.lastname: Enyinnaya
authors.forename: Joel G
authors.initials: JG
authors.lastname: Anderson
authors.forename: Elizabeth I
authors.initials: EI
authors.lastname: Merwin
authors.forename: Ann Gill
authors.initials: AG
authors.lastname: Taylor
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001168:Arthritis / Q000191:economics* / Q000628:therapy*; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D026882:Manipulation, Chiropractic / Q000191:economics* / Q000706:statistics & numerical data*; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D012423:Rural Health; D014481:United States; D055815:Young Adult