Shi Leiyu, Macinko James, Starfield Barbara, Politzer Robert, Xu Jiahong
Department of Health Policy and Management, Johns Hopkins School of Public Health & Hygiene, Baltimore, MD 21205-1996, USA.
Soc Sci Med. 2005 Jul;61(1):65-75. doi: 10.1016/j.socscimed.2004.11.056. Epub 2005 Jan 22.
This study used US state-level data from 1985 to 1995 to examine the relationship of primary care resources and income inequality with all-cause mortality within the entire population, and in black and white populations. The study is a pooled ecological design with repeated measures using 11 years of state-level data (n=549). Analyses controlled for socioeconomic and demographic characteristics. Contemporaneous and time-lagged covariates were modeled, and all analyses were stratified by race/ethnicity. In all models, primary care was associated with lower mortality. An increase of one primary care doctor per 10,000 population was associated with a reduction of 14.4 deaths per 100,000. The magnitude of primary care coefficients was higher for black mortality than for white mortality. Income inequality was not associated with mortality after controlling for state-level sociodemographic covariates. The study provides evidence that primary care resources are associated with population health and could aid in reducing socioeconomic disparities in health.
本研究使用了1985年至1995年美国州级数据，以检验初级保健资源和收入不平等与全体人口以及黑人和白人人口全因死亡率之间的关系。该研究是一项采用11年州级数据（n = 549）的重复测量混合生态设计。分析控制了社会经济和人口特征。对同期和滞后协变量进行了建模，所有分析均按种族/族裔分层。在所有模型中，初级保健与较低死亡率相关。每10000人口中增加一名初级保健医生与每100000人死亡人数减少14.4例相关。黑人死亡率的初级保健系数幅度高于白人死亡率。在控制了州级社会人口协变量后，收入不平等与死亡率无关。该研究提供了证据，表明初级保健资源与人群健康相关，并有助于减少健康方面的社会经济差距。
