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August 2001, Vol 91, No. 8 | American Journal of Public Health 1246-1250
© 2001 American Public Health Association

RESEARCH

The Effect of Primary Care Physician Supply and Income Inequality on Mortality Among Blacks and Whites in US Metropolitan Areas

Leiyu Shi, DrPH, MBA and Barbara Starfield, MD, MPH

The authors are with the Department of Health Policy and Management, Johns Hopkins School of Public Health and Hygiene, Baltimore, Md.

Correspondence: Reprints will not be available from the author. Correspondence should be addressed to Leiyu Shi, DrPH, MBA, Department of Health Policy and Management, Johns Hopkins School of Public Health and Hygiene, 624 N Broadway, Room 409, Baltimore, MD 21205-1996 (e-mail: lshi{at}jhsph.edu).

Objectives. This study assessed whether income inequality and primary care physician supply have a different effect on mortality among Blacks compared with Whites.

Methods. We conducted a multivariate ecologic analysis of 1990 data from 273 US metropolitan areas.

Results. Both income inequality and primary care physician supply were significantly associated with White mortality (P < .01). After the inclusion of the socioeconomic status covariates, the effect of income inequality on Black mortality remained significant (P < .01), but the effect of primary care physician supply was no longer significant (P > .10), particularly in areas with high income inequality.

Conclusions. Improvement in population health requires addressing socioeconomic determinants of health, including income inequality and primary care availability and access.




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