Primary care, race, and mortality in US states
Section snippets
Background
In the past decade, substantial literature suggested a significant association between income inequality and mortality both in the US and abroad (Blakely, Lochner, & Kawachi, 2002; Wilkinson, 1996; Kennedy, Kawachi, & Prothrow-Stith, 1996; Lochner, Pamuk, Makuc, Kennedy, & Kawachi, 2001; Lynch et al., 1998; McLaughlin & Stokes, 2002; Subramanian, Blakely, & Kawachi, 2003). The greater the gap in income distribution between the rich and poor in a given area, the higher the mortality rate for the
Data and measures
Data for this study came from a variety of sources including the Compressed Mortality Files (US Department of Health and Human Services National Center for Health Statistics, 2000), the US Department of Commerce and the Census Bureau (1985), US Department of Commerce and the Census Bureau (1986), US Department of Commerce and the Census Bureau (1987), US Department of Commerce and the Census Bureau (1988), US Department of Commerce and the Census Bureau (1989), US Department of Commerce and the
Results
During 1985–1995, there was a decline in all-cause mortality. The mean state age-adjusted mortality rate dropped from 821 to 762 per 100,000 population (Fig. 1, Panel 1). In the same period, there was a steady increase in primary care physicians, from 5.02 to 6.04 per 10,000 population (Fig. 1, Panel 2). Income inequality within states fluctuated during the period with an overall worsening trend: the mean of the Gini coefficient among states increased from 0.41 to 0.43 during the period (Fig. 1
Discussion
This study confirmed earlier findings that primary care was associated with lower mortality and partially mediated the association between socioeconomic variables and mortality (Shi, Starfield, Kennedy, & Kawachi (1999), Shi, Starfield, Politzer, & Regan (2002); Shi & Starfield (2001), Shi, Starfield, Kennedy, & Kawachi (1999)). These findings are significant because they provide more robust evidence of a relationship between primary care physicians and lower state mortality than was possible
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Physician characteristics and distribution in the United States
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