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Research Article

Residential Segregation and the Availability of Primary Care Physicians

  1. Darrell J. Gaskin1,*,
  2. Gniesha Y. Dinwiddie2,
  3. Kitty S. Chan3,
  4. Rachael R. McCleary4

Article first published online: 23 APR 2012

DOI: 10.1111/j.1475-6773.2012.01417.x

Issue

Health Services Research

Health Services Research

Volume 47, Issue 6, pages 2353–2376, December 2012

Additional Information

How to Cite

Gaskin, D. J., Dinwiddie, G. Y., Chan, K. S. and McCleary, R. R. (2012), Residential Segregation and the Availability of Primary Care Physicians. Health Services Research, 47: 2353–2376. doi: 10.1111/j.1475-6773.2012.01417.x

Author Information

  1. 1

    Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD

  2. 2

    African American Studies Department, Maryland Population Research Center, University of Maryland, College Park, MD

  3. 3

    Department of Health Policy and Management, Hopkins Center for Health Disparities Solutions, Health Services Research and Development Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD

  4. 4

    Hopkins Center for Health Disparities Solution, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD

*Address correspondence to Darrell J. Gaskin, Ph.D., Deputy Director, Hopkins Center for Health Disparities Solutions, Associate Professor of Health Economics, Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Suite 441, Baltimore, Maryland 21205; e-mail: dgaskin@jhsph.edu.

Publication History

  1. Issue published online: 12 NOV 2012
  2. Article first published online: 23 APR 2012

Funded by

  • National Institute on Minority Health and Health Disparities

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Keywords:

  • Primary care;
  • racial;
  • ethnic;
  • health care disparities;
  • segregation;
  • physician shortage

Objective

To examine the association between residential segregation and geographic access to primary care physicians (PCPs) in metropolitan statistical areas (MSAs).

Data Sources

We combined zip code level data on primary care physicians from the 2006 American Medical Association master file with demographic, socioeconomic, and segregation measures from the 2000 U.S. Census. Our sample consisted of 15,465 zip codes located completely or partially in an MSA.

Methods

We defined PCP shortage areas as those zip codes with no PCP or a population to PCP ratio of >3,500. Using logistic regressions, we estimated the association between a zip code's odds of being a PCP shortage area and its minority composition and degree of segregation in its MSA.

Principal Findings

We found that odds of being a PCP shortage area were 67 percent higher for majority African American zip codes but 27 percent lower for majority Hispanic zip codes. The association varied with the degree of segregation. As the degree of segregation increased, the odds of being a PCP shortage area increased for majority African American zip codes; however, the converse was true for majority Hispanic and Asian zip codes.

Conclusions

Efforts to address PCP shortages should target African American communities especially in segregated MSAs.

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