Office of Planning, Analysis, and Evaluation, Health Resources and Services Administration, US Department of Health and Human Services, Rockville, Maryland.
Office of Health Equity, Health Resources and Services Administration, US Department of Health and Human Services, Rockville, Maryland.
JAMA Netw Open. 2023 Apr 3;6(4):e236687. doi: 10.1001/jamanetworkopen.2023.6687.
Studies have suggested that greater primary care physician (PCP) availability is associated with better population health and that a diverse health workforce can improve care experience measures. However, it is unclear whether greater Black representation within the PCP workforce is associated with improved health outcomes among Black individuals.
To assess county-level Black PCP workforce representation and its association with mortality-related outcomes in the US.
DESIGN, SETTING, AND PARTICIPANTS: This cohort study evaluated the association of Black PCP workforce representation with survival outcomes at 3 time points (from January 1 to December 31 each in 2009, 2014, and 2019) for US counties. County-level representation was defined as the ratio of the proportion of PCPs who identifed as Black divided by the proportion of the population who identified as Black. Analyses focused on between- and within-county influences of Black PCP representation and treated Black PCP representation as a time-varying covariate. Analysis of between-county influences examined whether, on average, counties with increased Black representation exhibited improved survival outcomes. Analysis of within-county influences assessed whether counties with higher-than-usual Black PCP representation exhibited enhanced survival outcomes during a given year of heightened workforce diversity. Data analyses were performed on June 23, 2022.
Using mixed-effects growth models, the impact of Black PCP representation on life expectancy and all-cause mortality for Black individuals and on mortality rate disparities between Black and White individuals was assessed.
A combined sample of 1618 US counties was identified based on whether at least 1 Black PCP operated within a county during 1 or more time points (2009, 2014, and 2019). Black PCPs operated in 1198 counties in 2009, 1260 counties in 2014, and 1308 counties in 2019-less than half of all 3142 Census-defined US counties as of 2014. Between-county influence results indicated that greater Black workforce representation was associated with higher life expectancy and was inversely associated with all-cause Black mortality and mortality rate disparities between Black and White individuals. In adjusted mixed-effects growth models, a 10% increase in Black PCP representation was associated with a higher life expectancy of 30.61 days (95% CI, 19.13-42.44 days).
The findings of this cohort study suggest that greater Black PCP workforce representation is associated with better population health measures for Black individuals, although there was a dearth of US counties with at least 1 Black PCP during each study time point. Investments to build a more representative PCP workforce nationally may be important for improving population health.
研究表明，初级保健医生（PCP）人数的增加与更好的人口健康状况有关，而多元化的医疗保健人员队伍可以提高护理体验措施。然而，目前尚不清楚 PCP 劳动力中黑人代表人数的增加是否与黑人个体的健康结果改善有关。
评估美国县级黑人 PCP 劳动力代表人数及其与死亡率相关结局之间的关联。
设计、地点和参与者：这项队列研究评估了黑人 PCP 劳动力代表人数与美国各县三个时间点（2009 年、2014 年和 2019 年 1 月 1 日至 12 月 31 日）生存结果之间的关联。县级代表性定义为自我认同为黑人的 PCP 比例除以自我认同为黑人的人口比例。分析侧重于黑人 PCP 代表性的县间和县内影响，并将黑人 PCP 代表性视为随时间变化的协变量。县间影响分析检验了平均而言，黑人代表人数增加的县是否表现出改善的生存结果。县内影响分析评估了在特定的劳动力多元化年份中，黑人 PCP 代表人数高于正常水平的县是否表现出更高的生存结果。数据分析于 2022 年 6 月 23 日进行。
使用混合效应增长模型，评估了黑人 PCP 代表性对黑人个体的预期寿命和全因死亡率的影响，以及对黑人与白人个体之间死亡率差异的影响。
根据 2009 年、2014 年和 2019 年期间至少有 1 名黑人 PCP 在一个县或多个县开展业务的情况，确定了一个由 1618 个美国县组成的综合样本。黑人 PCP 在 2009 年开展业务的县有 1198 个，在 2014 年开展业务的县有 1260 个，在 2019 年开展业务的县有 1308 个，不到截至 2014 年的所有 3142 个人口普查定义的美国县的一半。县间影响结果表明，黑人劳动力代表人数的增加与更高的预期寿命有关，并且与全因黑人死亡率和黑人与白人个体之间的死亡率差异呈负相关。在调整后的混合效应增长模型中，黑人 PCP 代表性增加 10%与预期寿命增加 30.61 天（95%CI，19.13-42.44 天）相关。
这项队列研究的结果表明，黑人 PCP 劳动力代表人数的增加与黑人个体的更好的人口健康指标有关，尽管在每个研究时间点，美国都有很少的县至少有 1 名黑人 PCP。在全国范围内投资建立更具代表性的 PCP 劳动力队伍，对于改善人口健康状况可能很重要。
