title: Relationship between local family physician supply and influenza vaccination after controlling for individual and neighborhood effects.
abstract: BACKGROUND
  Family physicians (FPs) play an important role in influenza vaccination. We investigated how local FP supply is associated with influenza vaccination, controlling for both individual-level and county-level characteristics.
  
  
  METHODS
  The 2008-2010 individual-level data from the Behavioral Risk Factor Surveillance System were merged with county-level data from the Area Resource File (n = 985,157). Multivariate logistic analyses were performed to predict influenza vaccination using the number of FPs per 1000 population as the key predictor, adjusting for individual-level demographic, socioeconomic, and health information, as well as county-level racial composition and income level. Additional analyses were performed across racial/ethnic and employment status categories.
  
  
  RESULTS
  Increasing local FP supply was associated with higher odds (adjusted odds ratio [aOR], 1.58; 95% confidence interval [CI], 1.49-1.67) and varied across racial/ethnic groups (Hispanic: aOR, 2.05, 95% CI, 1.55-2.72; non-Hispanic white: aOR, 1.57, 95% CI, 1.48-1.66; non-Hispanic black: aOR, 1.49, 95% CI, 1.18-1.89), employment status categories, and county types.
  
  
  CONCLUSIONS
  FP supply was significantly associated with influenza vaccination. The association was greatest among those who were Hispanic, residing in a rural area, or out of work. Our findings lend support to initiatives aimed at increasing the FP supply, particularly among disadvantaged populations.
authors.affiliation: Economics Division, Babson College, Babson Park, MA. Electronic address: ygai@babson.edu.
authors.forename: Yunwei
authors.initials: Y
authors.lastname: Gai
authors.affiliation: College of Pharmacy, University of New Mexico, Albuquerque, NM.
authors.forename: Ning Yan
authors.initials: NY
authors.lastname: Gu
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D007252:Influenza Vaccines / Q000008:administration & dosage*; D007251:Influenza, Human / Q000517:prevention & control*; D008297:Male; D008875:Middle Aged; D010821:Physicians, Family / Q000706:statistics & numerical data*; D014611:Vaccination / Q000706:statistics & numerical data*; D055815:Young Adult
chemical_list: D007252:Influenza Vaccines
keywords: Area Resource Files; Behavioral Risk Factor Surveillance System; Contextual and neighborhood characteristics; Family physician shortage; Health care disparity