The 131st Annual Meeting (November 15-19, 2003) of APHA

The 131st Annual Meeting (November 15-19, 2003) of APHA

4036.0: Tuesday, November 18, 2003 - 9:42 AM

Abstract #68177

Relationship Between Primary Care, Income Inequality, and Mortality in U.S. States, 1980-1995

John T. Wulu, PhD1, Leiyu Shi, DrPH, MBA2, James Macinko, PhD2, Barbara Starfield, MD, MPH2, Jerrilynn Regan, RN, MS, MPA3, and Robert Politzer, ScD1. (1) Office of Data, Evaluation, Analysis & Research, Bureau of Primary Health Care, HRSA/DHHS, 4350 East West Highway, 7th floor, Bethesda, MD 20814, 301-594-3730,, (2) Department of Health Policy and Management, Johns Hopkins University School of Hygiene and Public Health, 624 N. Broadway, Room 409, Baltimore, MD 21212, (3) Bureau of Primary Health Care, East West Towers, 4350 East West Highway, Bethesda, MD 20814

Objectives: This study tested the robustness of the relationships between primary care, income inequality, and population health by a) assessing the relationship during four time periods--1980, 1985, 1990 and 1995; b) examining the independent effect of components of the primary care physician supply; c) utilizing two different measures of income inequality; and d) testing the robustness of the association by using five-year time-lagged independent variables. Methods: Data were derived from the Compressed Mortality Files, the US Department of Commerce and the Census Bureau, the National Center for Health Statistics, the CDC and the AMA Physician Master File. The unit of analysis was U.S. states over a 15-year period using ecological, cross-sectional design. The main outcome measure was age-standardized all-cause mortality per 100,000 population in all U.S. states over the time periods. Mortality data were obtained and directly standardized for age to the 1980 US population. Results: In multivariate regressions, both contemporaneous and time-lagged income inequality measures were significantly associated with all-cause mortality (p<0.05). Contemporaneous and time-lagged primary care physician to population ratios were significantly associated with lower all-cause mortality (p<0.05 for all 4 time periods), while specialty care measures were associated with higher mortality (p<0.05 for all time periods, except 1990, where p<0.1). Among primary care subspecialties, only family medicine was consistently associated with lower mortality (p<0.01 for all time periods). Conclusions: Enhancing primary care, particularly family medicine, even in states with high levels of income inequality, could lead to lower all-cause mortality in those states.

Learning Objectives:

Keywords: Epidemiology, Access and Services

Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.

Behavior, Lifestyle and Social Determinants of Health: Session II

The 131st Annual Meeting (November 15-19, 2003) of APHA