Area-Level socioeconomic disadvantage and access to primary care: A rapid review

Abstract

Social drivers of health aggregate geographically, contributing to health inequities that primary care access may mitigate. Two area-level measures of social disadvantage are the Area Deprivation Index and Social Vulnerability Index. This rapid review aimed to assess the association between these measures and primary care access. We conducted a rapid review of US studies published through February 11, 2025. Included studies were categorized as defining primary care access by self-reported access to primary care, geographic accessibility, or utilization. We analyzed 31 studies, of which 68% (N = 9/13 Area Deprivation Index, N = 12/18 Social Vulnerability Index) found that greater area-level social disadvantage was consistently associated with reduced primary care access. This association was most consistently observed in studies measuring primary care access via self-report (N = 2/2), vaccine uptake (N = 5/7), and via a higher odds of using telephone vs audio-visual or in-person primary care in areas of high socioeconomic disadvantage (N = 5/5). These findings have implications for telemedicine payment policy and care redesign. The possible expiration of Medicare's expanded telemedicine reimbursement may disproportionately reduce access points to primary care for individuals living in high socioeconomic disadvantage areas. These findings also support the need for community-level interventions to increase access to primary care administered vaccines.

Keywords: access; area deprivation index; area-level socioeconomic disadvantage; primary care; social vulnerability index.

Figure 1.

Flow diagram for rapid review search. Abbreviations: ADI, Area Deprivation Index; SVI, Social Vulnerability Index.

Figure 2.

Measures of primary care access in included studies.