title: Primary care, income inequality, and stroke mortality in the United States: a longitudinal analysis, 1985-1995.
abstract: OBJECTIVE
  The goal of this study was to test whether primary care reduces the impact of income inequality on stroke mortality.
  
  
  METHODS
  This study used pooled time-series cross-sectional analysis of 11 years of state-level data (n=549). Analyses controlled for education levels, unemployment, racial/ethnic composition, and percent urban. Contemporaneous and time-lagged covariates were modeled.
  
  
  RESULTS
  Primary care was negatively associated with stroke mortality in models including all covariates (P<0.0001). The impact of income inequality on stroke mortality was reduced in the presence of primary care (P<0.0001) but disappeared with the addition of covariates (P>0.05).
  
  
  CONCLUSIONS
  In the absence of social policy that addresses sociodemographic determinants of health, primary care promotion may serve as a palliative strategy for combating stroke mortality and reducing the adverse impact of income inequality on health.
authors.affiliation: Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, 624 N Broadway, Room 409, Baltimore, MD 21205, USA. lshi@jhsph.edu
authors.forename: Leiyu
authors.initials: L
authors.lastname: Shi
authors.forename: James
authors.initials: J
authors.lastname: Macinko
authors.forename: Barbara
authors.initials: B
authors.lastname: Starfield
authors.forename: Jiahong
authors.initials: J
authors.lastname: Xu
authors.forename: Robert
authors.initials: R
authors.lastname: Politzer
mesh_terms: D003430:Cross-Sectional Studies; D006801:Humans; D007182:Income; D008137:Longitudinal Studies; D015233:Models, Statistical; D011320:Primary Health Care / Q000706:statistics & numerical data*; D012044:Regression Analysis; D012923:Social Class; D012959:Socioeconomic Factors; D020521:Stroke / Q000191:economics* / Q000401:mortality*; D013995:Time; D014481:United States / Q000453:epidemiology; D000078329:Workforce