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Research ArticleOriginal Article

The Relationship Between Primary Care, Income Inequality, and Mortality in US States, 1980–1995

Leiyu Shi, James Macinko, Barbara Starfield, John Wulu, Jerri Regan and Robert Politzer
The Journal of the American Board of Family Practice September 2003, 16 (5) 412-422; DOI: https://doi.org/10.3122/jabfm.16.5.412
Leiyu Shi
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James Macinko
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Barbara Starfield
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John Wulu
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Jerri Regan
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Robert Politzer
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Article Figures & Data

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    Table 1.

    Correlations between Primary Care, Specialty Care, Income Inequity, and Standardized Mortality, US States 1980–1995

    Age-Standardized Deaths per 100,000 Population from All Causes
    1980198519901995
    Gini Coefficent
     Same period.42‡.39‡.55‡.28†
     Prior period.46‡.48‡.55‡
    Robin Hood
     Same period.42‡.42‡.48‡.25*
     Prior period.46‡.51‡.52‡
    Specialty Care
     Same period.13.02−.09−.13
     Prior period−.11−.09−.18
    Primary Care
     Same period.30†−.18−.26*−.29†
     Prior period−.30†−.25*−.34†
    Family Medicine
     Same period−.47‡−.35‡−.32†−.27*
     Prior period−.50‡−.31†−.25*
    Internal Medicine
     Same period−.10−.03−.11−.18
     Prior period−.09−.11−.19
    Pediatrics
     Same period−.08−.01−.07−.05
     Prior period−.07−.07−.16
    • * P < .1

    • † P < .05

    • ‡ P < .01

    • n = 50

    • View popup
    Table 2.

    Regression Coefficients of Primary Care, Specialty Care, and Income Inequity on Standardized Mortality, US States 1980–1995

    Age-Standardized Deaths per 100,000 Population from All Causes
    1980198519901995
    Intercept463.02478.09286.37554.65
    [205.22][168.10][174.85][44.11]
    Gini Coefficient1249.121003.571324.50719.14
    [488.89][385.87][380.33][342.59]
    (2.56‡)(2.60‡)(3.48‡)(2.10†)
    Primary Care−37.69−33.80−25.99−35.53
    [13.85][12.48][11.90][11.25]
    (−2.72‡)(−2.71‡)(−2.19†)(−3.16‡)
    Specialty Care15.7816.4610.5614.98
    [7.03][6.52][6.20][6.79]
    (2.24†)(2.53†)(1.70*)(2.21†)
    R2.30.27.35.28
    Adjusted R2.25.22.31.23
    F Ratio6.46‡5.55‡8.28‡5.99‡
    • Parameter estimates on top, standard errors in brackets, t values in parentheses.

    • * P < .1

    • † P < .05

    • ‡ P < .01

    • n = 50

    • View popup
    Table 3.

    Regression Coefficients of Primary Care Subspecialties, Specialty Care, and Income Inequity on Standardized Mortality, US States 1980–1995

    Age-Standardized Deaths per 100,000 Population from All Causes
    1980198519901995
    Intercept751.19613.25442.69632.56
    [213.11][184.90][204.43][186.78]
    Gini Coefficent954.55950.421204.1657.30
    [466.39][386.51][391.2][364.39]
    (2.05†)(2.46†)(3.08‡)(1.80*)
    Specialty Care−1.733.551.275.48
    [10.22][9.89][9.82][11.20]
    (−.17)(.36)(.13)(.49)
    Family Medicine−70.94−50.69−41.10−38.69
    [16.60][15.68][15.42][14.59]
    (−4.27‡)(−3.23‡)(−2.67‡)(−2.65‡)
    Internal Medicine7.80−12.36−8.56−29.82
    [19.98][19.31][17.52][14.69]
    (.39)(−.64)(−.49)(−2.03†)
    Pediatrics−72.28−27.69−32.43.43
    [58.68][52.60][48.76][38.02]
    (−1.23)(−.53)(−.67)(.01)
    R2.43.32.38.30
    Adjusted R2.36.24.31.22
    F Ratio6.53‡4.09‡5.47‡3.78‡
    • Parameter estimates on top, standard errors in brackets, t values in parentheses.

    • * P < .1

    • † P < .05

    • ‡ P < .01

    • n = 50

    • View popup
    Table 4.

    Regression Coefficients of Primary Care, Specialty Care, and Income Inequity on Standardized Mortality, US States 1980–1995

    Age-Standardized Deaths per 100,000 Population from All Causes
    1985 Mortality/1980 Predictors1990 Mortality/1985 Predictors1995 Mortality/1990 Predictors
    Intercept431.84381.90319.50315.12306.26239.75
    [176.77][196.22][155.22][166.73][166.36][175.06]
    Robin Hood Index16.9518.3818.29
    [5.83][4.91][5.08]
    (2.91‡)(3.75‡)(3.60‡)
    Gini Coefficient1339.851341.011447.93
    [467.46][382.73][380.79]
    (2.87‡)(3.50‡)(3.80‡)
    Primary Care−40.16−39.87−33.53−34.28−29.58−25.19
    [13.18)[13.24][12.22][12.38)[11.76][11.91]
    (−3.05‡)(−3.01‡)(−2.75‡)(−2.77†)(−2.52†)(−2.12†)
    Specialty Care17.7617.3115.0815.2010.948.14
    [6.69][6.72][6.37][6.46][6.12][6.20]
    (2.66‡)(2.58‡)(2.37†)(2.35†)(1.79*)(1.31)
    R2.34.34.36.34.37.39
    Adjusted R2.30.30.32.30.33.35
    F Ratio7.96‡7.86‡8.72‡8.01‡9.15‡9.76‡
    • Parameter estimates on top, standard errors in brackets, t values in parentheses.

    • * P < .1

    • † P < .05

    • ‡ P < .01

    • n = 50

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The Journal of the American Board of Family Practice: 16 (5)
The Journal of the American Board of Family Practice
Vol. 16, Issue 5
1 Sep 2003
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The Relationship Between Primary Care, Income Inequality, and Mortality in US States, 1980–1995
Leiyu Shi, James Macinko, Barbara Starfield, John Wulu, Jerri Regan, Robert Politzer
The Journal of the American Board of Family Practice Sep 2003, 16 (5) 412-422; DOI: 10.3122/jabfm.16.5.412

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The Relationship Between Primary Care, Income Inequality, and Mortality in US States, 1980–1995
Leiyu Shi, James Macinko, Barbara Starfield, John Wulu, Jerri Regan, Robert Politzer
The Journal of the American Board of Family Practice Sep 2003, 16 (5) 412-422; DOI: 10.3122/jabfm.16.5.412
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