PROPERWW“*


PUBLICATIONSBRA@ff ~<:;~:-,-- J -j~~ - ~~


EDITORIAL LIBMRY o~ “ 

FROM VITAL & HEALTH STATISTICS OF THE NATIONAL CENTER FOR HEALTH STATISTICS 

U.S. DEPARTMENT OF HEALTH. EDUCATION, AND WELFARE � Public Health Service I Number 24 � March 24, 1978 

Utilization of Selected Medical Practitioners: 

United States, 19741 

Some ambulatory medical care is provided 

each year by a wide variety of nonphysician 

health care personnel, referred to in this report 

“medic al practitioners.”* $3 This report 

~~esents estimates from the 1974 Health Interview Survey on the number and percent of the 

U.S. civiIian noninstitutionalized population 

who consulted a chiropractor, a podiatrist/ 

chiropodist, or physicial therapist during a 

12-month reference period. Further details on 

the survey design are given in the Technical 

Notes. 

Data on the use of chiropractors and podiatrists were coI1ected previously in the Health Interview Interview Survey during 1963-64. (See 

footnote 2.) It should be noted, however, that 

the data from these two surveys are not strictly 

comparable. Different questions were used in 

each survey period. Moreover, the 1963-64 questions were asked on a household basis for each 

household member, and proxy responses as well 

as seIf-responses were accepted. The 1974 items 

1This report prepared by Lonnie Jean Howie, Division of Health Interview Statistics. 

2National Center for Health Statistics: Characteristics 

of patients of selected types of medical specialists and 

practitioners, United States, July 1963-June 1964. Vital 

and Health Statistics. PHS Pub. No. 1000-Senes 10-No. 

28. Public Health Service. Washington. U.S. Government 

Printing Office, May 1966. 

3 Schach, E., Kalimo, E,, and Crawford, J.: Use of 

selected nonphysician health care personnel services, in 

R. Kohn and K. L. White, eds., Health Ca7e: An 

International Study. New York. Oxford University Press, 

1976. pp. 329-350. 

were asked on a self-respondent basis. In addition, the 1963-64 questions were asked as part 

of a specizd supplement on medical specialists 

and practitioners. The 1974 items were asked as 

part of a special supplement on sources of and 

barriers to medicaI care. 

According to responses to a special question 

in the 1974 Health Interview Survey on medical 

practitioners, an estimated 3.6 percent of the 

population (7.5 miIlion persons) used the services of a chiropractor; 2.4 percent (5.0 miI1ion 

persons) consulted a podiatrist or a chiropodist; 

and 1.6 percent (3.2 miIIion persons) used the 

services of a physical therapist. (See chart on 

page “2:) Contact with each of these practitioners 

was, with some exceptions, proportionately 

more prevalent among older and white persons 

than it was amofig younger persons and persons 

in alI other color groups. A more detailed discussion on the. use of these medical practitioners 

among various groupings of the population is 

given. 

USE OF CHIROPRACTORS 

An estimated 3.6 percent of the population 

consulted a chiropractor at least once during the 

12 months preceding the interview (table 1), 

There was some variation in the use of chiropractors among the various categories of the 

population, ranging from 0.7 percent for children under 6 years of age to 6.6 percent for 

farm residents. 

Among persons under 65 years of age, the 

likelihood of consulting a chiropractor was 
2 &~ , ,,., ‘, ,’,,.- “,, , .’,, ’;” 

,.. , ., ‘! ”,,, . . s“, ,“ ‘.,,

,0 .,. ,. .,. 

PERCENT OF POPULATION CONSULTING SELECTEO MEDlcAL PRACTITIONERS DURING A 12-McYNTH PERIOq,’ ~“” 

BY SELECTED CHARACTERISTIC: UNITED STATES, 1974 

.; ,. 

W Under 6years ‘

ALL PERSONS AGE ,’, COLOR 

7.0 m 6.16 wars 

7 T 

6 

5 

54 

~ 

%!3 

2 

1 

0 ~hiropratior Podiatrist/ Phvsicdl Podiatrist/ Physical therapist Chiropodist therapist Chiropodist 

greater for each older age group. During the survey year 0.7 percent of children under 6 years of 

age and 6.2 percent of adults aged 45 to 64 

years consulted a chiropractor. However, the utilization rate drops to 3.9 percent for persons 65 

years of age and over. 

Use of chiropractors was greater among 

white persons (4.0 percent) than among persons 

in all other color groups (1.0 percent). Proportionately, for families with an annual income of 

less than $15,000, there was a tendency for utilization to increase as family income increased. 

The rate decreased to 3.5 percent for families 

with higher incomes, which is similar to the proportion for all persons. Contact with a chiropractor was also greater among persons living in 

the West (5.0 percent) and North Central Regions (4.2 percent) than among persons living in 

the other geographic regions. Contact with a chiropractor was more prevalent among persons residing outside standard metropolis an statistical 

areas (5. 1 percent) than among persons living 

within such areas (3.0 percent). Within standard 

metropolitan statistical areas (SMSA’S), central 

city dwellers consulted a chiropractor less often 

(2.4 percent) than did SMSA residents outside 

the central city (3.4 percent). Outside SMSA’S 

the percent of persons who received services 

from a chiropractor during the survey year was 

higher among residents in farm areas (6.6 percent) than among residents in nonfarm areas � 

(4.9 percent). 

Differences also occurred among usual activity status groupings, with proportionately more 

persons who were working, keeping house, or 

retired than persons in the other activity status 

groupings seeing a chiropractor (table 1). 

Whereas the overall estimate of percents for 

males is slightly higher than that for females, the 

differences can be accounted for by sampling 

variability, as is the case with the differences by 

sex for the selected sociodemographic variables. 

USE OF PODIATRISTS 

An estimated 2.4 percent of the population 

saw a podiatrist at least once during the 12 

months preceding the interview (table 2). As. few 

as 0.8 percent of persons living in farm areas 

outside. of SMSA’S and as many as 7.0 percent of 

persons 65 years and over consulted a podiatrist 

during the 12-month reference period. Proportionately more white persons (2.5 percent) saw a 

podiatrist than did persons in all other color 

groups (1.7 percent). 

The use of podiatrists also varied somewhat Q! 

among age, sex, family income, usual activity 
---------------------------------

----------------

� ammedaa3 

Tablel. Number and percent of persons who received services from a chiropractor during


the year preceding time of interview, by sex and selected characteristics: United


States, 1974


Both
 Characteristic
 sexes


Number of persons who Percent of persons
 received service in who received service
 thousands


All personal------------------- 7,527 3,811 3,715 3.6 3.8 3.5


Age


Under 6 years------------------------ 130 1$+ 0.7 0.7 

6-16 years--------------------------- 533 3% 1.2 n

17-24 years-------------------------- 966 478 488 H 

25-44 years-------------------------- 2,345 1,229 1,206 u ::: 

45-64 years-------------------------- 2,650 1,326 1,325 6.2 ::; 5.9 

65 years and over-------------------- 812 374 438 3.9 4.4 3.6 

Color


� 

White-------------------------------- 7,252 3,680 3,;:; 4.0 4.2 3.8 

All other---------------------------- 275 132 1.0 1.1 1.0 

Family income 

Less than $2,000--------------------- 208 156 2.8 2.0 3.3 

$2,000-$3,999------------------------ 506 1;; 314 3.1 3.0 3.2 

$4,000-$6,999------------------------ 1,064 504 559 3.7 

$7,000-$9,999------------------------ 1,086 494 592 ::; N 

$10,000-$14,999---------------------- 2,115 1,111 1,005 4.1 ::; 4.0 

$15,000 or more---------------------- 2,229 1,303 927 3.5 4.1 3.0 

Usual activity status2 

Going to school---------------------- 837 486 352 

Working------------------------------ 4,058 2,669 1,389 ;:? u ::; 

Keeping house------------------------ 1,856 ... 1,856 4.7 ... 4.7 

Retired------------------------------ 497 482 5.3 5.6 2.0 

Other-------------------------------- 148 105 ;; 2.8 3.3 2.1 

Geographic region 

Northeast---------------------------- 1,645 837 808 

North Central------------------------ 2,353 1,156 1,198 ::: ::! ::; 

South-------------------------------- 1,657 818 839 2.5 2.6 

West 1,871 1,001 870 5.0 5.5 ;:: 

Place of residence


0 

SMSA--------------------------------- 4,266 2,189 2,078 3.0 3.2 

Central city----------------------- 1,531 794 737 2.4 $:: 

Outside central city--------------- 2,735 1,394 1,341 ?:: 

Outside SMSA------------------------- 3,260 1,623 1,638 H M 

Nonfarm------------ 2,760 1,340 1,419 4.9 u 4.9 

Farm------------------------------- 500 282 218 6.6 7.2 6.0 

lIncludesunknown income.


2Excludes children under 6 years of age.

--------

--------------

----------------------

---------------------------------

� 

4 akmdata � 

Table 2. Number and percent of persons who received services from a podiatrist during


the year preceding time of interview, by sex and selected characteristics: United


States, 1974


Characteristic


All personal-------------------


Age


Under 6 years------------------------
 6-16 years---------------------------
 17-24 years--------------------------
 25-44 years--------------------------


45-64 years--------------------------
 65 years and over--------------------


Color


White------------------------


All other----------------------------


Family income


Less than $2,000-------


$2,000-$3,999------------------------


$4,000-$6,999------------------------


$7,000-$9,999------------------------


$10,000-$14,999----------------------


$15,000 or more


Usual activity status2


Going to school----------------------
 Working------------------------------
 Keeping house------------------------
 Retired------------------------------
 Other--------------------------------


Geographic region


Northeast----------------------------
 North Central------------------------
 South--------------------------------


West


Place of residence


SMSA---------------------------------
 Central city-----------------------
 Outside central city---------------
 Outside SMSA-------------------------
 Nonfarm----------------------------
 Farm-------------------------------


Both IIMale Female sexes 

Number of persons who


received service in


thousands


4,978 1,629 3,349


239 127 112 

339 208 191 

330 153 177 

801 304 498 

1,747 463 1,285 

1,460 373 1,087 

4,526 1,460 3,066


452 170 283


205 44 160 

468 387 

728 2;: 474 

551 207 344 

988 401 587 

1,688 578 1,110 

489 241 248 

1,902 854 1,048 

1,747 1,747 

425 iii 

176 71 1:: 

1,932 559 1,373


1,429 528 901


863 317 547


754 225 529


3,988 1,230 2,758


1,960 590 1,370


2,029 640 1,388


990 399 591


931 377 554


59 22 37


Percent of persons


who received service


2.4 1.6 3.1


1.2 1.3 

0.9 1.0 

1.1 1.1 

1:9 

::? ;:: 5.7 

7.0 4.3 8,9 

2.5 1.7 3.3


1.7 1.4 2.0


2.8 1.7 3.4 

2.9 3.9 

2.5 ::; 

2,0 1.6 H 

;:? ::: ::; 

0.9 0.9 0.9 

1.7 3.6 

::: ... 4.5 3.9 1::: 

3,4 2.2 5.2 

2.4 5.3 

;:: 2.0 ;.; 

1.0 

;:; 1.2 2:8 

2.8 1.8


;:; 

$:: ::: 

1.3 1:8 

::2 1..9 

0.8 ;:: 1.0 

@


lIncludes unknown income.


2Excludes children under 6 years of age.

acmncedata 5 

status, place of residence, and geographic region 

groups. Proportionately more females (3.1 percent) saw a podiatrist than did males (1.6 percent). The likelihood of consulting a podiatrist is 

greater among older persons. During the survey 

year” 1.2 percent of children under 6 years of age 

and 7.0 percent of adults 65 years of age and 

over consulted a podiatrist. Among persons with 

family incomes of less than $15,000, there was a 

slight inverse relationship between income and 

the use of podiatrists. The usual activity categories that had the greatest percent of persons 

consulting a podiatrist were persons keeping 

house and retired persons. Contact with a podiatrist was proportionately less frequent among 

persons living in the South (1.3 percent) and in 

the West Regions (2.0 percent) than among persons living in the other two regions. Proportionately more persons residing within SMSA’S (2.8 

percent) consulted a podiatrist than did persons 

residing outside SMSA’S (1.5 percent). Within 

SMSA’S, central city residents consulted a podiatrist more often (3. 1 percent) than did residents . outside the central city (2.5 percent). Outside 

SMSA’S, the percent of persons who received 

services from a podiatrist was higher among nonfarm dwellers (1.6 percent ) than it was among 

farm dwellers (0.8 percent). 

While there were some exceptions among the 

sociodemographic groups, these differences in 

the use of podiatrists also occurred for each sex 

considered separately. Among females, however, 

the differences were usually more pronounced. 

For instance, among the age groups the range for 

females was from 0.9 percent to 8.9 percent, 

while for males a much smaller range was found, 

from 1.0 percent to 4.3 percent. 

USE OF PHYSICAL THERAPISTS 

An estimated 1.6 percent of the population 

saw a physical therapist at least once during the 

< ‘ 

L./ 

12 months preceding the interview (table 3). 

There was less variation in the utilization rates 

of physical therapists among categories of the 

population compared with the use of chiropractors and podiatrists. The range was from 0.4 percent for children under 6 years of age to 3.2 

percent for retired persons. 

The differences for sex, color, and place of 

residence groups with respect to the utilization 

of physic’<herapists were within the range associated with the sample variation of the estimates. However, substantial differences in the 

use of physical therapists occurred among age, 

family income, usual activity status, and geographic region groups. The likelihood of contacting a physical therapist tended to increase with 

age. During the survey year 0.4 percent of children under 6 years of age and 2.3 percent of 

adults 45-64 years of age consulted a physical 

therapist. The slight difference between the percents shown for persons 65 years of age and over 

and for persons 45-64 years is within the sampling variability of the two estimates. Persons with 

family incomes of less than $4,000 and persons 

in the income range of $7,000 to $9,999 consulted a physical therapist proportionately more 

often than did persons in other family income 

groups. Proportionately more persons keeping 

house and retired persons consuIted a physical 

therapist; however, the “other” usual activity 

group also had a relatively large percent (5.8) of 

persons who consulted a physical therapist 

(table 3). Contact with a physical therapist was 

more likely among persons living in the West 

(1.9 percent) and North Central Regions (1.7 

percent) than among persons in the other two 

geographic regions. 

The data for males and females shown in 

table 3 indicate only one notable difference between the sexes in the use of physical therapists; 

retired females (7.8 percent) consulted a physical therapist proportionately more often than 

did retired males (2.8 percent). 
----------------------

----------------------

------------------------------

------------------------

------------------------------ --------------------------------

----------------------------

------------------------ --------------------------------

---------------------------------

-----------------------

-------------------------

----------------------------

-------------------------------

n 

6 

Table 3. Number and percent of persons who received services from a physical therapist 

during the year preceding time of interview, by sex and selected characteristics: 

United States, 1974 

II

II I 

Characteristic Both Male Female ;exes 

Both Male Female ;exes 

II i II I 

kunber of persons who 

received service in 

thousands 

Percent of persons 

who received service 

All personsl------------------- 3,242 1,581 1,660 1.6 1.6 1.5


Under 6 years------------------------- 86 53 0.4 0.5 0.4 

6-16 years--------------------------- 294 181 1?: 0.7 0.8 0.5 

17-24 years-------------------------- 383 213 171 1.1 

25-44 years-------------------------- 1,034 567 467 ;:; ;:: 

45-64 years-------------------------- 984 419 565 2.3 2.1 R 

65 years and over-------------------- 460 149 311 2,2 1.7 2.6 

Color


white-------------------------------- 2,869 1,384 1,485 1.6 1.6 1.6 

All other---------------------------- 372 197 175 1.4 1.6 1.2 -

Family income 

Less than $2,000---------------------

$2,000-$3,999------------------------

145 

377 1:; 100 

234 

2.0 

2.3 ;:; 

2.1 

2.4 

$4,000-$6,999------------------------ 464 274 190 1.6 2.0 

$7,000-$9,999------------------------ 501 217 285 1.6 

$10,000-$14,999---------------------- 680 382 297 R 

$15,000 or more 889 458 430 1,4 H 

Usual activity statusz


Going to school 417 246 171 0.8 0.9 0.6 

Working 1,325 861 465 1.7 1.6 

Keeping house 811 .,. 811 ;:: ... 2.0 

Retired 298 239 2.8 

Other 305 182 1$; ;:: 5.7 ::: 

Geographic region 

Northeast 

North Central 

701 

954 

342 

457 

359 

498 H 

1.5 

1.7 H 

South 870 434 436 1.4 1.3 

West 715 348 367 ::; 1.9 1.9 

Place of residence 

SMSA--------------------------------- 2,268 1,048 1,220 1.6 1.5 1.6 

Central city 1,029 470 559 1.6 1.6 1.7 

Outside central city--------------- 1,239 578 661 

Outside SMSA 973 533 440 ::z H 

Nonfarm 891 476 415 1,7 

Fare 83 57 26 ::: 1.5 , 

Irncludes unknown income-


2Excludes children under 6 years of age.


— 
-. abmecMa7 

TECHNICAL NOTES 

The data presented in this report were ob- Table 1. Standard errors of estimates of aggregates 

tained from household interviews in the Health 

Interview Sumey. These interviews were con- Size of estimate Standard error 

ducted throughout 1974 in a probability sample in thousends in thousands 

of the civilian noninstitutionalized population of 

the United States. During that year approxi- 70 .............................................. 21 

mately 116,000 persons living in about 40,000 100 ......... ................ ................... 25 

households were included in the sample. The 300 ................................. ........ ... 43 

500 ............................................ 55 questions on utilization of medical practitioners 700 ............................................ 65 

were asked of each household member who was 1,000 ......................................... 78 

identified as a “sample person. ” This subsample	 5,000 ......................................... 173 

10,000....................................... 243 included approximately 37,062 persons. 20,000 ....................................... 337 

For a detailed discussion of the limitations 30,000 ....................................... 405 

and qualifications of data collected in the Health	 50,000 ....................................... 501 

100,000 ..................................... 626 Interview Survey, see an earlier report entitled 

“Current Estimates from the Health Interview 

Survey, United States, 1974,” Vital and Health


Statistics, Series 10, No. 100, DHEW Publication Table 11. Standard errors, expressed in percentage points, of


No. (HRA) 76-1527. estimate( percentages 

/---- The sampling pattern for sample person se- Estimated percentage 

lection was based on the total number of related — — 

and 

sons (a one-third subsample of the actual Health in thousands 

:8 :; ‘% 

50 

Interview Survey sample) were selected by the — 

interviewer at the time of interview. To determine which household member(s) to designate 70 ..... ........................ ............. 

100 ......... .. .............. ........ ....... 

4.1 

3.5 

6.4 

5.4 

8.9 

7.4 

11.8 

9.9 

14.8 

12.4 

as a sample person, the interviewer referred to a 300 ... ...... ........ ........ ........ ....... 2.0 3.1 4.3 5.7 7.1 

preselected flashcard after listing all related and 

unrelated persons in the household on the ques500 ........................................ 

700 ......... .. ...... .. ............ ........ . 

1,000 ..................... .. ........ ...... 

1.5 

1.3 

1.1 

2.4 

2.0 

1.7 

3.3 

2.8 

2.3 

4.4 

3.7 

3.1 

5.5 

4.7 

3.9 

tionnaire. The flashcard contained, for each 5,000 ...... ...................... ......... 0.5 0.8 1.0 1.4 1.7 

household size, one or more person numbers 10,000 .................. ................. 0.3 0.5 0.7 1.0 1.2 

that were to be identified as the sample person(s). 

20,000 ..... ...... ........ ......... ....... 

30,000 ........ ............ .... .... ...... . 

50,000 .... .......... ............ .. .. .... . 

0.2 

0.2 

0.2 

0.4 

0.3 

0.2 

0.5 

0.4 

0.3 

0.7 

0.6 

0.4 

0.9 

0.7 

0.6 

Since the estimates shown are based on a 100,000 ................. .. ...... .. ...... 0.1 0.2 0.2 0.3 0.4 

unrelated household members. Sample per- Baseof percentage .02 05 10 

sample of the population rather than on the en-


tire population, they are subject to sampling


error. Standard errors appropriate for the esti­


mates of the number of persons are shown in “less.” etc.), indicate that differences are statis­


table I; standard errors appropriate for percent- tics.lly significant. The t test with a critical value


ages are shown in table II. of 1.96 (0.05 level of significance) was used to


In this report, terms such as “similar” and test all comparisons which are discussed. Lack of 

“the same” mean that no statistical significance comment regarding the difference between any 

exists between the statistics being compared. two statistics does not mean the difference was 

Terms relating to differences (i.e., “greater,” tested and found to be not significant. 
---------------------------------- ---

---------------------------

------------------------------------------

---------------------------

8 dmcdata . 

SYMBOLS 

Data not available 

Category not applicable . . . 

Quantity zero -

Quantity more than O but less than 0.05----- 0.0 

Figure does not meet standards of * reliability y or precision 

Recent Issues of Advance Data From Vital and Health Statistics 

No. 23.	 Office Vkits to General Surgeons: National No. 20. Office Visits to Obstetrician-Gy necologists: 

Ambulatory Medical Care Survey, United National Ambulatory Medical Care Survey, 

States, 1975 (Issued: March 24, 1978) United States, 1975 (Issued: March 13, 1978) 

No. 22. Office Wits by Persons Aged 65 and Over: No. 19. Exercise and Participation in Sports Among 

National Ambulatory Medical Care Survey, Persons 20 Years of Age and Over: United 

United States, 1975 (Issued: March 22, 1978) States, 1975 (Issued: March 15, 1978) 

No. 21.	 Selected Flndhygs of Dietary Food Consumption Profiles of Persons 1-74 Years of Age in 

the United States, 1971-74 (In preparation) 

A complete list of Advance Data From Vital and Health Statistics is available from the Scientific and Technical 

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