Primary care, income inequality, and stroke mortality in the United States: A longitudinal analysis, 1985-1995

Leiyu Shi, James Macinko, Barbara Starfield, Jiahong Xu, Robert Politzer

Research output: Contribution to journalArticle


Background and Purpose - The goal of this study was to test whether primary care reduces the impact of income inequality on stroke mortality. Methods - This study used pooled time-series cross-sectional analysis of 11 years of state-level data (n = 549). Analyses controlled for education levels, unemployment, racial/ethnic composition, and percent urban. Contemporaneous and time-lagged covariates were modeled. Results - Primary care was negatively associated with stroke mortality in models including all covariates (P<0.0001). The impact of income inequality on stroke mortality was reduced in the presence of primary care (P<0.0001) but disappeared with the addition of covariates (P>0.05). Conclusions - In the absence of social policy that addresses sociodemographic determinants of health, primary care promotion may serve as a palliative strategy for combating stroke mortality and reducing the adverse impact of income inequality on health.

Original languageEnglish (US)
Pages (from-to)1958-1964
Number of pages7
Issue number8
StatePublished - Aug 1 2003



  • Mortality
  • Primary health care
  • Socioeconomic factors
  • Stroke prevention

ASJC Scopus subject areas

  • Clinical Neurology
  • Cardiology and Cardiovascular Medicine
  • Advanced and Specialized Nursing

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