title: Primary care, race, and mortality in US states.
abstract: This study used US state-level data from 1985 to 1995 to examine the relationship of primary care resources and income inequality with all-cause mortality within the entire population, and in black and white populations. The study is a pooled ecological design with repeated measures using 11 years of state-level data (n=549). Analyses controlled for socioeconomic and demographic characteristics. Contemporaneous and time-lagged covariates were modeled, and all analyses were stratified by race/ethnicity. In all models, primary care was associated with lower mortality. An increase of one primary care doctor per 10,000 population was associated with a reduction of 14.4 deaths per 100,000. The magnitude of primary care coefficients was higher for black mortality than for white mortality. Income inequality was not associated with mortality after controlling for state-level sociodemographic covariates. The study provides evidence that primary care resources are associated with population health and could aid in reducing socioeconomic disparities in health.
authors.affiliation: Department of Health Policy and Management, Johns Hopkins School of Public Health & Hygiene, Baltimore, MD 21205-1996, 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: Robert
authors.initials: R
authors.lastname: Politzer
authors.forename: Jiahong
authors.initials: J
authors.lastname: Xu
mesh_terms: D001741:Black or African American; D006295:Health Resources; D006801:Humans; D009026:Mortality / Q000639:trends*; D011320:Primary Health Care; D012959:Socioeconomic Factors; D014481:United States / Q000453:epidemiology; D044465:White People