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Primary care, race, and mortality in US states
Leiyu Shi1, James Macinko, Barbara Starfield
1Department of Health Policy and Management, Johns Hopkins School of Public Health & Hygiene, Baltimore, MD 21205-1996, USA. lshi@jhsph.edu
Social Science & Medicine (1982)
|April 26, 2005
Summary
Increased primary care access significantly lowers all-cause mortality, particularly for Black populations. This study highlights primary care
Area of Science:
- Public Health
- Health Services Research
- Epidemiology
Background:
- Primary care access is crucial for population health.
- Socioeconomic factors like income inequality may influence mortality rates.
- Racial disparities in health outcomes persist in the US.
Purpose of the Study:
- To investigate the association between primary care resources and all-cause mortality.
- To examine the role of income inequality in population mortality.
- To analyze these relationships across different racial groups (Black and White populations).
Main Methods:
- Pooled ecological study design using US state-level data from 1985-1995 (n=549).
- Analyses controlled for socioeconomic and demographic factors.
- Stratified analyses by race/ethnicity, modeling contemporaneous and time-lagged covariates.
Main Results:
- Primary care physicians were significantly associated with lower all-cause mortality.
- Each additional primary care doctor per 10,000 population correlated with a 14.4 deaths per 100,000 reduction.
- The impact of primary care on mortality was more pronounced in the Black population compared to the White population.
- Income inequality showed no significant association with mortality after controlling for covariates.
Conclusions:
- Adequate primary care resources are linked to improved population health outcomes.
- Primary care may play a role in mitigating socioeconomic disparities in mortality.
- Policy interventions focusing on primary care access could reduce health inequities.