Primary care, income inequality, and stroke mortality in the United States: a longitudinal analysis, 1985-1995.
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.
Shi
Leiyu
L
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
Macinko
James
J
Starfield
Barbara
B
Xu
Jiahong
J
Politzer
Robert
R
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