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. 2003 Aug;34(8):1958-64.
doi: 10.1161/01.STR.0000082380.80444.A9. Epub 2003 Jul 3.

Primary care, income inequality, and stroke mortality in the United States: a longitudinal analysis, 1985-1995

Leiyu Shi  1 , James Macinko, Barbara Starfield, Jiahong Xu, Robert Politzer
Affiliations

Primary care, income inequality, and stroke mortality in the United States: a longitudinal analysis, 1985-1995

Leiyu Shi et al. Stroke. 2003 Aug.

Abstract

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.

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