Primary care, race, and mortality in US states

Leiyu Shi, James Macinko, Barbara Starfield, Robert Politzer, Jiahong Xu

Research output: Contribution to journalArticlepeer-review

66 Scopus citations


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.

Original languageEnglish (US)
Pages (from-to)65-75
Number of pages11
JournalSocial Science and Medicine
Issue number1
StatePublished - Jul 2005


  • Ethnicity
  • Mortality
  • Primary care resources
  • USA

ASJC Scopus subject areas

  • Health(social science)
  • History and Philosophy of Science


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