title: Access to Primary Care in US Counties Is Associated with Lower Obesity Rates.
abstract: BACKGROUND
  Obesity causes substantial morbidity and mortality in the United States. Evidence shows that primary care physician (PCP) supply correlates positively with improved health, but its association with obesity in the United States as not been adequately characterized. Our purpose was to characterize the association between PCP supply in US counties and adult obesity.
  
  
  METHODS
  We performed a multivariate logistic regression analysis to examine the relationship between county-level PCP supply and individual obesity status. We controlled for individual variables, including sex, race, marital status, income, and insurance status, and county-level variables, including rurality and poverty.
  
  
  RESULTS
  Higher county-level PCP supply was associated with lower adult obesity after controlling for common confounders. Individuals living in counties with the most robust PCP supply were about 20% less likely to be obese (P ≤ .01) than those living in counties with the lowest PCP supply.
  
  
  CONCLUSIONS
  While the observed association between the supply of PCPs and lower rates of obesity may not be causal, the association warrants further investigation. This may have important implications for restructuring the physician workforce in the context of the current PCP shortage and implementation of the Affordable Care Act and the patient-centered medical home.
authors.affiliation: From the Department of Family Medicine, National Center for Primary Care, Morehouse School of Medicine, Atlanta, GA (AHG); and the Robert Graham Center, Washington, DC (SP, AB, RP). agaglioti@msm.edu.
authors.forename: Anne H
authors.initials: AH
authors.lastname: Gaglioti
authors.affiliation: From the Department of Family Medicine, National Center for Primary Care, Morehouse School of Medicine, Atlanta, GA (AHG); and the Robert Graham Center, Washington, DC (SP, AB, RP).
authors.forename: Stephen
authors.initials: S
authors.lastname: Petterson
authors.affiliation: From the Department of Family Medicine, National Center for Primary Care, Morehouse School of Medicine, Atlanta, GA (AHG); and the Robert Graham Center, Washington, DC (SP, AB, RP).
authors.forename: Andrew
authors.initials: A
authors.lastname: Bazemore
authors.affiliation: From the Department of Family Medicine, National Center for Primary Care, Morehouse School of Medicine, Atlanta, GA (AHG); and the Robert Graham Center, Washington, DC (SP, AB, RP).
authors.forename: Robert
authors.initials: R
authors.lastname: Phillips
mesh_terms: D000328:Adult; D005260:Female; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D015999:Multivariate Analysis; D009765:Obesity / Q000453:epidemiology*; D058991:Patient Protection and Affordable Care Act; D018802:Patient-Centered Care / Q000379:methods / Q000639:trends; D058007:Physicians, Primary Care / Q000706:statistics & numerical data*; D015995:Prevalence; D012424:Rural Population / Q000706:statistics & numerical data; D014481:United States / Q000453:epidemiology; D014505:Urban Population / Q000706:statistics & numerical data; D000078329:Workforce
keywords: Access to Health Care; Geographic Accessibility; Health Services; Obesity; Primary Health Care; Public Health