Complementary and Alternative Medicine Use and All-Cause Mortality Among US Adults: A National Prospective Cohort Study.

Abstract

Although complementary and alternative medicine (CAM) practices are widely used across the US population, population-level associations with mortality remain understudied. This study examined exploratory associations between CAM use patterns and all-cause mortality among US adults. Data from the National Health Interview Survey (2007/2012, N=55,023) were linked to mortality through 2019 (5,530 deaths; 472,636.5 person-years). This analysis examined 21 specific CAM modalities, CAM usage intensity, recency of use, and theoretically and empirically derived domains using Cox proportional hazards models with hierarchical covariate adjustment, Benjamini-Hochberg false discovery rate correction, and exploratory subgroup analyses. 43.2% of adults engaged in 1+ CAM practice. After full adjustment and FDR correction, yoga (HR=0.73, 95% CI: 0.62-0.87) and Pilates (HR=0.64, 95% CI: 0.49-0.85) were associated with lower mortality. Each additional CAM practice was associated with 6% lower mortality (HR=0.94, 95% CI: 0.92-0.96). Recent users had lower mortality than past-only users (HR=0.79 vs. 0.90), and multiple practice users showed the strongest association (HR=0.76, 95% CI: 0.68-0.86). Exploratory subgroup analyses revealed suggestive but largely non-robust patterns. Most individual CAM modalities showed null associations with mortality, but yoga and Pilates demonstrated inverse associations that persisted after adjustment and FDR correction, and broader measures of CAM engagement consistently indicated lower mortality risk. Whether these associations reflect CAM-specific benefits or general physical activity and health-conscious selection warrants further investigation.