Untangling the association between the burden of chronic back problems, current utilization of chiropractic care, and availability of chiropractors at the health region level: an ecological study protocol.

BACKGROUND: Chronic back problems (cBP) are the leading cause of disability in Canada, with chiropractors as second most-consulted professionals for cBP care. However, little is known about chiropractor supply, demand, and gaps between them. We will determine the prevalence of cBP, chiropractic utilization, the chiropractic availability across Canadian health regions; compute a demand-supply measure; and investigate characteristics associated with the demand-supply.

METHODS: We designed an ecological study with 102 Canadian health regions as the unit of analysis. We will estimate derived and observed demand using the Canadian Community Health Survey data (2015/2016, 2021/2022), and supply using Canadian Chiropractic Association membership data (2021/2022). We will use spatial analyses to map the prevalence of cBP (derived demand), chiropractic utilization for cBP (observed demand), and chiropractor availability (supply) across health regions. Poisson regression models will assess the population factors associated with supply and demand-supply disparities.

CONCLUSION: The identification of geographical disparities in chiropractic care and the exploration of contextual factors associated with demand-supply dynamics may inform healthcare planning and resource allocation for the management of chronic back problems in Canada.