Online Program

Neighborhood Socioeconomic Status and Access to Primary Care in Greater Philadelphia

Tuesday, November 3, 2015 :

Mustafa Hussein, PhD, Department of Epidemiology and Biostatistics, Drexel University School of Public Health, Philadelphia, PA
Ana V. Diez Roux, MD, PhD, Department of Epidemiology, Drexel University, Philadelphia, PA
Robert I. Field, JD, MPH, PhD, Department of Health Management and Policy, Drexel University Dornsife School of Public Health, Philadelphia, PA
Using neighborhood income to measure contextual socioeconomic status (SES), we examined the association of neighborhood SES with primary healthcare access and whether this association changed overtime. Besides improving our understanding of how socioeconomic context independently influences individuals’ access, this study may also be timely for urban policy efforts to support expanding access under the Affordable Care Act. We used repeated cross-sectional data (2002-2012) on 55,795 adult respondents to a regional health survey in Philadelphia and neighboring counties. We measured access as: having any usual source of care (USC), using safety-net resources (community health centers, emergency and outpatient departments) as a USC, and having cost or transportation barriers to care. We used Census tracts as a proxy for neighborhoods, and linked the survey to Census sociodemographic data and healthcare supply data in primary care service areas. Using multi-level logistic regression models with a random-intercept for neighborhoods, we estimated contextual associations of neighborhood SES with access, adjusted for within-neighborhood distributions of individual SES as well as other confounders. While we observed no association with having any USC, a $10,000-increase in a neighborhood’s income was associated with 6% less reliance on safety-net resources for primary healthcare among its residents. Likewise, a similar increase was associated with 4% and 5% lower likelihood of cost and transportation barriers to access, respectively (all p<0.01). Longitudinal trends showed some decline in these associations in recent years, suggesting potentially increasing reliance on the safety net and growing experience of barriers to access by populations of more socioeconomically diverse contexts.

Learning Areas:

Conduct evaluation related to programs, research, and other areas of practice
Provision of health care to the public
Public health or related public policy
Social and behavioral sciences

Learning Objectives:
Describe the ways in which the socioeconomic context of a neighborhood may independently determine its residents' access to primary healthcare

Keyword(s): Health Care Access, Underserved Populations

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I hold a PhD in Health Policy and currently work (as a postdoctoral fellow in social epidemiology) on multiple projects related to the socioeconomic context of neighborhoods and how it affects a range of health outcomes. My previous work focused on the role of expanding insurance coverage in addressing disparities in healthcare access and the use of analytical methods to seek explanations for these disparities.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.