Primary care, social inequalities and all-cause, heart disease and cancer mortality in US counties

A comparison between urban and non-urban areas

L. Shi, J. Macinko, B. Starfield, R. Politzer, J. Wulu, J. Xu

Research output: Contribution to journalArticle

Abstract

Objective: The objective of this study was to test whether the association between primary care and income inequality on all-cause, heart disease and cancer mortality at county level differs in urban (Metropolitan Statistical Area-MSA) compared with non-urban (non-MSA) areas. Study design: The study consisted of a cross-sectional analysis of county-level data stratified by MSA and non-MSA areas in 1990. Dependent variables included age and sex-standardized (per 100,000) all-cause, heart disease and cancer mortality. Independent variables included primary care resources, income inequality, education levels, unemployment, racial/ethnic composition and income levels. Methods: One-way analysis of variance and multivariate ordinary least squares regression were employed for each health outcome. Results: Among non-MSA counties, those in the highest income inequality category experienced 11% higher all-cause mortality, 9% higher heart disease mortality, and 9% higher cancer mortality than counties in the lowest income inequality quartile, while controlling for other health determinants. Non-MSA counties with higher primary care experienced 2% lower all-cause mortality, 4% lower heart disease mortality, and 3% lower cancer mortality than non-MSA counties with lower primary care. MSA counties with median levels of income inequality experienced approximately 6% higher all-cause mortality, 7% higher heart disease mortality, and 7% higher cancer mortality than counties in the lowest income inequality quartile. MSA counties with low primary care (less than 75th percentile) had significantly lower levels of all-cause, heart disease and cancer mortality than those counties with high primary care. Conclusions: In non-MSA counties, increasing primary physician supply co uld be one way to address the health needs of rural populations. In MSA counties, the association between primary care and health outcomes appears to be more complex and is likely to require intervention that focuses on multiple fronts.

Original languageEnglish (US)
Pages (from-to)699-710
Number of pages12
JournalPublic Health
Volume119
Issue number8
DOIs
StatePublished - Aug 2005

Fingerprint

Heart Neoplasms
heart disease
social inequality
Heart Diseases
Primary Health Care
cancer
mortality
cause
Mortality
income
health
Health
low income
Neoplasms
Unemployment
difference in income
rural population
Rural Population
Least-Squares Analysis
analysis of variance

Keywords

  • Health inequalities
  • Primary care
  • Social epidemiology
  • Urban health

ASJC Scopus subject areas

  • Health(social science)

Cite this

Primary care, social inequalities and all-cause, heart disease and cancer mortality in US counties : A comparison between urban and non-urban areas. / Shi, L.; Macinko, J.; Starfield, B.; Politzer, R.; Wulu, J.; Xu, J.

In: Public Health, Vol. 119, No. 8, 08.2005, p. 699-710.

Research output: Contribution to journalArticle

Shi, L. ; Macinko, J. ; Starfield, B. ; Politzer, R. ; Wulu, J. ; Xu, J. / Primary care, social inequalities and all-cause, heart disease and cancer mortality in US counties : A comparison between urban and non-urban areas. In: Public Health. 2005 ; Vol. 119, No. 8. pp. 699-710.
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