Patterns of complementary and alternative medicine use among United States stroke survivors

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Abstract

Background

Americans are increasingly searching for complementary and alternative remedies. Some data suggest that persons who use Complementary and Alternative medicine (CAM) are at a higher risk for interactions with prescription medications. We assessed CAM use among American stroke survivors as little is known about CAM in this population.

Methods

We compared CAM use in adults with and without stroke who participated in the most comprehensive national survey on CAM use to date, the 2002 National Health Interview Survey. Independent predictors of CAM use among stroke survivors were assessed with logistic regression.

Results

Of 30,992 adults, 2.6% indicated a history of stroke, with 46% of these stroke survivors reporting CAM use. Acupuncture was the only CAM therapy used more frequently in stroke survivors (OR 1.53, 95% CI = 1.07–2.19, p = 0.02). In multivariable analyses among stroke survivors, CAM use was more frequent among those who reported delays in seeking medical care due to cost (OR 2.28, 95% CI = 1.28–4.07, p = 0.005) or those with recent neck pain, (OR 2.28, 95% CI = 1.48–3.52, p = 0.002) and less frequent among those > 65 years (OR 0.54, 95% CI = 0.31–0.96, p = 0.035), non-Hispanic Blacks (OR 0.57, 95%CI = 0.33–1.0, p = 0.049), and those with less than high school education (OR 0.33, 95% CI = 0.22–0.51, p < 0.001).

Conclusions

Approximately half the stroke survivors in the United States engage in some form of CAM therapy, with those reporting delays in seeking medical care due to cost, or recent neck pain being more likely to pursue CAM treatment.

Introduction

Complementary and alternative medicine (CAM) is considered unconventional by the American medical system and is not taught widely at U.S. medical schools or generally available at U.S. hospitals [1]. Nonetheless, the use of CAM is widespread and increasing as more Americans are searching for unconventional therapies to treat their chronic illnesses [1], [2], [3]. One national survey indicated that CAM use increased from 33.7% to 42.1% during the 1990s [3]. It is believed that Americans spent between $36 and $42 billion on CAM therapies in 1997 [2], with out-of-pocket expenditures comparable to that spent for all conventional physician services. There were an estimated 629 million total visits to alternative medicine practitioners, thereby exceeding total visits to all primary care physicians [3].

Patients who use CAM generally do so as a complement to conventional medicine rather than as an alternative [1], [3], [4], [5], [6], [7], but they are typically unaware of the potential toxicities of CAM and the possible adverse interactions with prescription medications [8], [9], [10]. Although there are reports on herbal medicine use in acute stroke patients and a recent meta-analysis of the use of traditional Chinese patent medicines for ischemic stroke in China [11], [12], little is known about the use of the myriad of available CAM therapies among stroke survivors in Western industrialized nations. Understanding the prevalence and patterns of CAM use among stroke patients could be a first step towards targeting educational efforts and improving communication between physicians and their stroke patients. In this study, we aimed to determine the national patterns of CAM use among stroke survivors in the United States.

Section snippets

Methods

Data from the 2002 National Health Interview Survey (NHIS) conducted by the Centers for Disease Control and Prevention's National Center for Health Statistics (NCHS) were accessed online from the public use data files available from the NCHS Web site at: http://www.cdc.gov/nchs/nhis.htm. The NHIS is a yearly survey of a nationally representative sample of the civilian non-institutionalized household population of the United States. The NHIS sample is selected by a complex sampling design

Results

There were 31,044 completed surveys in the 2002 NHIS and 30,992 adults (99.8%) had complete information on stroke. Of these patients, 2.6% (n = 791) indicated a history of stroke. The prevalence of stroke increased with age (0.2% among those aged 18–34, 0.8% among those aged 35–49, 3.1% among those aged 50-64, and 8.6% among those older than 65). Forty-six percent (95% CI = 42.2–49.6) of the stroke patients used some form of CAM. Twenty percent used herbal medicine (Table 1). After adjusting for

Discussion

Our study found that almost half the number of stroke survivors in the United States reported the use of some form of CAM therapy. These results underscore the widespread use of CAM among Americans, and falls within the range of the 29 to 62% of Americans surveyed in various studies who reported using at least one form of CAM therapy during the preceding year [1], [2], [3]. Our estimate of CAM use among individuals with a history of stroke is also comparable to those noted in individuals with

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