Racial and Ethnic Representation Among Complementary and Integrative Health Program Graduates

Background: Use of complementary and integrative health care (CIH) varies across racial and ethnic groups in the United States. Lack of racial and ethnic diversity among CIH providers may hinder access to CIH for underrepresented groups. This study aimed to (1) document racial and ethnic representation in licensed CIH professions (chiropractic, acupuncture, traditional East Asian medicine, naturopathic medicine, direct-entry midwifery, and massage therapy), non-licensed CIH professions, and conventional health care; (2) compare diversity in these professions with the U.S. population; and (3) examine changes in CIH diversity in recent years. Methods: We conducted a repeated cross-sectional study design with the 2011-2022 Integrated Postsecondary Education Data System to examine race and ethnicity among graduates in licensed CIH professions, compared with non-licensed CIH professions and conventional health care. Our sample included 53,393 programs representing 3,524,494 individuals. We examined the proportion of graduates from each racial and ethnic group, compared results with the U.S. population, and graphically explored changes between 2011 and 2022. Results: Inclusion or exclusion of massage therapy influenced interpretations across all questions. With massage therapy, licensed CIH professions appeared more diverse, with a higher proportion of Latino and Black graduates. Without massage therapy, diversity in licensed CIH professions was similar or slightly reduced compared with non-licensed CIH professions and conventional health care. Notable differences emerged among licensed CIH professions: acupuncture and East Asian medicine had larger proportions of Asian graduates than other CIH programs and the U.S. population. Racial and ethnic diversity in CIH increased modestly between 2011 and 2022. Discussion: While professions such as massage therapy, acupuncture, and traditional East Asian medicine have greater diversity, a disparity persists between the racial and ethnic composition of licensed CIH professions and the diversity of the overall U.S. population.