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(Stroke. 2003;34:1958.)
© 2003 American Heart Association, Inc.

Original Contributions

Primary Care, Income Inequality, and Stroke Mortality in the United States

A Longitudinal Analysis, 1985–1995

Leiyu Shi, MBA, DrPH; James Macinko, PhD; Barbara Starfield, MD, MPH; Jiahong Xu, MS, MPH Robert Politzer, ScD

From the Johns Hopkins Bloomberg School of Public Health (L.S., J.M., B.S., J.X.) and Bureau for Primary Care, Health Resources and Services Administration, US Department of Health and Human Services (R.P.), Baltimore, Md.

Reprint requests to Leiyu Shi, MBA, DrPH, Associate Professor, Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, 624 N Broadway, Room 409, Baltimore, MD 21205. E-mail lshi{at}jhsph.edu

Background and Purpose— The goal of this study was to test whether primary care reduces the impact of income inequality on stroke mortality.

Methods— 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.

Results— 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).

Conclusions— 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.

Key Words: mortality • primary health care • socioeconomic factors • stroke prevention

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