Neighborhood Socioeconomic Status and Access to Primary Care in Greater Philadelphia

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.