Primary care, self-rated health, and reductions in social disparities in health.
OBJECTIVE
To examine the extent to which good primary-care experience attenuates the adverse association of income inequality with self-reported health.


METHODS
Data for the study were drawn from the Robert Wood Johnson Foundation sponsored 1996-1997 Community Tracking Study (CTS) Household Survey and state indicators of income inequality and primary care.


METHODS
Cross-sectional, mixed-level analysis on individuals with a primary-care physician as their usual source of care. The analyses were weighted to represent the civilian noninstitutionalized population of the continental United States.


METHODS
Principal component factor analysis was used to explore the stricture of the primary-care indicators and examine their construct validity. Income inequality for the state in which the community is located was measured by the Gini coefficient, calculated using income distribution data from the 1996 current population survey. Stratified analyses compared proportion of individuals reporting had health and feeling depressed with those with good and bad primary-care experiences for each of the four income-inequality strata. A set of logistic regressions were performed to examine the relation between primary-care experience, income inequality, and self-rated health.


RESULTS
Good primary-care experience, in particular enhanced accessibility and continuity, was associated with better self-reported health both generally and mentally. Good primary-care experience was able to reduce the adverse association of income inequality with general health although not with mental health, and was especially beneficial in areas with highest income inequality. Socioeconomic status attenuated, but did not eliminate, the effect of primary-care experience on health. In conclusion, good primary-care experience is associated not only with improved self-rated overall and mental health but also with reductions in disparities between more- and less-disadvantaged communities in ratings of overall health.
Department of Health Policy and Management, Johns Hopkins School of Public Health & Hygiene, Baltimore MD 21205-1996, USA.
Leiyu
L
Shi
Barbara
B
Starfield
Robert
R
Politzer
Jerri
J
Regan
D000328:Adult; D000368:Aged; D016001:Confidence Intervals; D003430:Cross-Sectional Studies; D003863:Depression / Q000453:epidemiology; D005260:Female; D006305:Health Status Indicators; D006801:Humans; D007182:Income / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D011203:Poverty / Q000706:statistics & numerical data; D011320:Primary Health Care / Q000706:statistics & numerical data*; D012647:Self-Assessment; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D014481:United States / Q000453:epidemiology