Primary Care, Self-rated Health, and Reductions in Social Disparities in Health
Article first published online: 9 OCT 2008
Health Services Research
Volume 37, Issue 3, pages 529–550, June 2002
How to Cite
Shi, L., Starfield, B., Politzer, R. and Regan, J. (2002), Primary Care, Self-rated Health, and Reductions in Social Disparities in Health. Health Services Research, 37: 529–550. doi: 10.1111/1475-6773.t01-1-00036
- Issue published online: 9 OCT 2008
- Article first published online: 9 OCT 2008
- Primary-care experience;
- income inequality;
- self-rated health
Objective. To examine the extent to which good primary-care experience attenuates the adverse association of income inequality with self-reported health.
Data Sources. Data for the study were drawn from the Robert Wood Johnson Foundation sponsored 1996–1997 Community Tracking Study (CTS) Household Survey and state indicators of income inequality and primary care.
Study Design. Cross-sectional, mixed-level analysis on individuals with a primary-care physician as their usual source of care. The analyses were weighted to represent the civilian noninstitutionalized population of the continental United States.
Data Collection/Extraction Methods. Principal component factor analysis was used to explore the structure of the primary-care indicators and examine their construct validity. Income inequality for the state in which the community is located was measured by the Gini coefficient, calculated using income distribution data from the 1996 current population survey. Stratified analyses compared proportion of individuals reporting bad health and feeling depressed with those with good and bad primary-care experiences for each of the four income-inequality strata. A set of logistic regressions were performed to examine the relation between primary-care experience, income inequality, and self-rated health.
Principal Findings. Good primary-care experience, in particular enhanced accessibility and continuity, was associated with better self-reported health both generally and mentally. Good primary-care experience was able to reduce the adverse association of income inequality with general health although not with mental health, and was especially beneficial in areas with highest income inequality. Socioeconomic status attenuated, but did not eliminate, the effect of primary-care experience on health. In conclusion, good primary-care experience is associated not only with improved self-rated overall and mental health but also with reductions in disparities between more- and less-disadvantaged communities in ratings of overall health.