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Leiyu Shi, DrPH, MBA, James Macinko, PhD, Barbara Starfield, MD, MPH, Robert Politzer, ScD, John Wulu, PhD and Jiahong Xu, MPH

Leiyu Shi is with the Department of Health Policy and Management at the Johns Hopkins Bloomberg School of Public Health, Baltimore, Md. James Macinko is with the Steinhardt School of Education at New York University, New York, NY. Barbara Starfield is with the Johns Hopkins Bloomberg School of Public Health. Robert Politzer and John Wulu are with the Bureau for Primary Care, Health Resources and Services Administration, US Department of Health and Human Services, Bethesda, Md. Jiahong Xu is a doctoral student at the Johns Hopkins Bloomberg School of Public Health.

Correspondence: Requests for reprints should be sent to Leiyu Shi, Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Room 406, Baltimore, MD 21205 (e-mail: lshi{at}jhsph.edu).

Objectives. We tested the association between the availability of primary care and income inequality on several categories of mortality in US counties.

Methods. We used cross-sectional analysis of data from counties (n=3081) in 1990, including analysis of variance and multivariate ordinary least squares regression. Independent variables included primary care resources, income inequality, and sociodemographics.

Results. Counties with higher availability of primary care resources experienced between 2% and 3% lower mortality than counties with less primary care. Counties with high income inequality experienced between 11% and 13% higher mortality than counties with less inequality.

Conclusions. Primary care resources may partially moderate the effects of income inequality on health outcomes at the county level.

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