Primary Care, Social Inequalities, and All-Cause, Heart Disease, and Cancer Mortality in US Counties, 1990

• DOI: 10.2105/ajph.2003.031716
• Publication Date: 2005-03-29T21:43:21Z
• Authors: Leiyu Shi; James Macinko; Barbara Starfield; Robert Politzer; John Wulu; Jiahong Xu
• Keywords: Adult; Male; Analysis of Variance; Heart Diseases; Primary Health Care; 1. No poverty; Middle Aged; Health Services Accessibility; United States; 3. Good health; 03 medical and health sciences; Cross-Sectional Studies; 0302 clinical medicine; Socioeconomic Factors; Cause of Death; Neoplasms; 8. Economic growth; Income; Humans; Regression Analysis; Female; 10. No inequality; Aged

Objectives. We tested the association between the availability of primary care and income inequality on several categories of mortality in US counties. Methods. We used cross-sectional analysis of data from counties (n=3081) in 1990, including analysis of variance and multivariate ordinary least squares regression. Independent variables included primary care resources, income inequality, and sociodemographics. Results. Counties with higher availability of primary care resources experienced between 2% and 3% lower mortality than counties with less primary care. Counties with high income inequality experienced between 11% and 13% higher mortality than counties with less inequality. Conclusions. Primary care resources may partially moderate the effects of income inequality on health outcomes at the county level.