Social determinants and variation in complementary and alternative medicine use: Difference or disparity?

Background: Race, ethnicity, socioeconomic position, and acculturation are recognized as social determinants of health and healthcare disparities by the Institute of Medicine. Although the effects of social factors on CAM utilization resemble patterns of conventional healthcare disparities, it is unclear whether variations in CAM use constitute differences or disparities. Using conceptual definitions of healthcare disparities, this study assesses variation in CAM use by race/ethnicity. Methods: Data from the 2002 and 2007 National Health Interview Survey were analyzed. Use of any type of CAM, practitioner-based CAM, self-care forms of CAM, and specific CAM domains were examined in both years. Analyses were performed with Stata 9.0 to account for complex survey design. Results: Non-Hispanic Whites were the highest users of 9 specific CAM domains and had the greatest increase in usage in the five year time span (a 24% increase from 36% in 2002 to 47% in 2007). Among African Americans, CAM use increased by 14%: from 26% in 2002 to 30% in 2007. Latinos (28% in 2002 vs. 26% in 2007) and Asians (43% in 2002 vs. 42% in 2007) exhibited slight decreases in CAM use excluding vitamins and prayer. Conclusion: Rates of CAM use suggest disparities in CAM utilization that mirror racial/ethnic disparities in conventional healthcare. Additional research among racial/ethnic groups is needed to further understand access to and utilization of CAM. Continued monitoring of CAM use is warranted to ensure safety and identify potential disparities in access to health resources.