Shi Leiyu, Macinko James, Starfield Barbara, Xu Jiahong, Politzer Robert
Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, 624 N Broadway, Room 409, Baltimore, MD 21205, USA.
Stroke. 2003 Aug;34(8):1958-64. doi: 10.1161/01.STR.0000082380.80444.A9. Epub 2003 Jul 3.
The goal of this study was to test whether primary care reduces the impact of income inequality on stroke mortality.
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.
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).
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.
本研究旨在检验初级保健是否能减轻收入不平等对中风死亡率的影响。
本研究采用对11年州级数据（n = 549）进行汇总的时间序列横断面分析。分析中控制了教育水平、失业率、种族/族裔构成以及城市人口百分比。对同期和滞后协变量进行建模。
在包含所有协变量的模型中，初级保健与中风死亡率呈负相关（P < 0.0001）。在有初级保健的情况下，收入不平等对中风死亡率的影响有所降低（P < 0.0001），但加入协变量后这种影响消失了（P > 0.05）。
在缺乏解决健康社会人口学决定因素的社会政策的情况下，推广初级保健可能是对抗中风死亡率以及减少收入不平等对健康的不利影响的一种缓解策略。
