Medicare Study Shows Wide State-by-State Differences in Neck Pain Treatment for Older Adults

Older adults who develop a new case of neck pain may receive very different care depending on the state where they live. A retrospective observational study in BMC Health Services Research examined Medicare fee-for-service claims and found major state-level differences in treatment patterns for newly diagnosed neck pain, with northern plains and mountain states showing greater use of chiropractic care and less use of primary care than many other parts of the country. The authors say the findings shed light on access to guideline-aligned care for a major source of disability in older people.

Using nationwide Medicare data, the researchers identified 236,995 fee-for-service beneficiaries who had an outpatient visit for newly diagnosed neck pain. They then calculated state-level utilization rates for neck pain care overall, along with separate rates for the two most common provider types: chiropractic and primary care. Across states, the average utilization rate for new neck pain was 188.72 per 1000 beneficiaries.

States in the northern plains and mountain regions stood out for higher overall neck pain care use, greater chiropractic utilization, and lower primary care use. In those areas, an older adult with neck pain was more likely to visit a chiropractor and less likely to see a primary care physician than someone in other regions of the United States. The team also examined how provider use related at the population level to sociodemographic and health factors.

Chiropractic use was linked with better overall population health and with higher rates of low back pain, another spinal condition frequently managed by the same provider group. By contrast, states with more low back pain tended to have lower primary care use for neck pain, suggesting that beneficiaries with a new neck pain diagnosis were less likely to be treated in primary care settings where low back pain was more common. The researchers also used regression models to explore which sociodemographic risk factors were associated with a patient's first choice between chiropractic and primary care.

The findings are interpreted in light of previous evidence that nonpharmacological therapies are unevenly available and used across the United States. Because clinical guidelines recommend nonpharmacological treatment as a first option for neck pain, understanding how older adults use these services can help reveal whether recommended care is reaching the people who need it. As with any claims-based observational study, however, the analysis has important limits.

It covers fee-for-service beneficiaries only and does not include Medicare Advantage enrollees, younger adults, or people whose neck pain never led to a billed outpatient visit. The state-level associations describe populations rather than individual decisions, so they do not prove that regional health status or low back pain prevalence caused the differences in provider choice. In addition, utilization rates reflect the number of visits, not the quality of care or patient outcomes, so the study cannot show whether higher chiropractic use improved pain relief or function.

Even with those limitations, the size of the variation is striking. The authors conclude that there is substantial geographic variation in specialty-based neck pain care among Medicare fee-for-service beneficiaries, along with meaningful associations between provider use and sociodemographic factors. They call for further research into disparities in neck pain care access and utilization across demographic groups, with the goal of supporting health equity efforts.

Subject of Research: Geographic variation in chiropractic and primary care utilization for new onset neck pain among Medicare fee-for-service beneficiaries

Article Title: Geographic variation in utilization of chiropractic and primary care for new onset neck pain among Medicare fee-for-service beneficiaries in the United States in 2021

Article References: Grout, L., Anderson, B., Hannah, A., MacKenzie, T., Moonaz, S., & Whedon, J. (2026). Geographic variation in utilization of chiropractic and primary care for new onset neck pain among Medicare fee-for-service beneficiaries in the United States in 2021. BMC Health Services Research. https://doi.org/10.1186/s12913-026-15531-w

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Keywords: neck pain, chiropractic, primary care, Medicare, geographic variation, health services research, older adults, spatial analysis, low back pain, health equity, claims data, nonpharmacological therapy

Cite Scienmag News

Ophelia Keating. Scienmag. https://scienmag.com/neck-pain-care-varies-sharply-by-state-among-older-americans-medicare-study-finds/

Ophelia Keating. "Neck Pain Care Varies Sharply by State Among Older Americans, Medicare Study Finds." Scienmag. https://scienmag.com/neck-pain-care-varies-sharply-by-state-among-older-americans-medicare-study-finds/.