Primary Care Experience and Racial Disparities in Self-Reported Health Status

Leiyu Shi; Lisa H. Green; Sophia Kazakova

doi:10.3122/jabfm.17.6.443

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Figure 1.
Health status odds ratios by 3 models (simple, with primary care, and with primary care and socioeconomic status).
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Figure 2.
Mental health status odds ratios by 3 models (simple, with primary care, and with primary care and socioeconomic status).

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Table 1.

Multivariate Analysis of Vulnerability, Primary Care Experiences, and Health (Odds Ratio (95% CI))

	Health Status (Modeling 1 = Poor Health)
	Model I	Model II	Model III
1996/1997
Vulnerability
White-Poverty	2.79 (2.50, 3.12)^***	2.60 (2.25, 3.02)^***	1.30 (1.11, 1.54)^**
White-above Poverty (ref)
Black-Poverty	3.07 (2.56, 3.69)^***	2.89 (2.32, 3.61)^***	1.61 (1.32, 1.97)^***
Black-above Poverty	1.51 (1.32, 1.73)^***	1.36 (1.17, 1.59)^***	1.32 (1.13, 1.53)^***
Hispanic-Poverty	4.28 (3.67, 4.99)^***	3.09 (2.48, 3.85)^***	1.58, 1.19, 2.09)^**
Hispanic-above Poverty	2.10 (1.87, 2.35)^***	1.41 (1.17, 1.69)^***	1.36 (1.12, 1.65)^**
Other-Poverty	3.69 (2.53, 5.39)^***	3.28 (2.07, 5.19)^***	2.33 (1.32, 4.13)^**
Other-above Poverty	1.17 (0.99, 1.37)	1.09 (0.88, 1.34)	0.96 (0.76, 1.21)
Primary Care
Accessibility		0.85 (0.83, 0.87)^***	0.92 (0.90, 0.94)^***
Interpersonal Relationship		0.93 (0.92, 0.95)^***	0.93 (0.91, 0.94)^***
Covariates^†
Sample size	60,446	37,039	37,039

1998/1999
Vulnerability
White-Poverty	2.68 (2.42, 2.96)^***	2.77 (2.43, 3.15)^***	1.54 (1.35, 1.77)^***
White-above Poverty (ref)
Black-Poverty	3.17 (2.71, 3.70)^***	2.89 (2.30, 3.65)^***	1.36 (1.03, 1.80)^*
Black-above Poverty	1.46 (1.29, 1.66)^***	1.38 (1.22, 1.56)^***	1.40 (1.23, 1.60)^***
Hispanic-Poverty	3.90 (3.31, 4.58)^***	3.06 (2.28, 4.12)^***	1.66 (1.22, 2.26)^**
Hispanic-above Poverty	1.76 (1.55, 2.00)^***	1.41 (1.19, 1.66)^***	1.48 (1.26, 1.73)^***
Other-Poverty	2.48 (1.81, 3.41)^***	1.98 (1.24, 3.18)^**	1.19 (0.70, 2.00)
Other-above Poverty	1.20 (1.03, 1.39)^*	1.30 (1.08, 1.57)^**	1.26 (0.98, 1.62)
Primary Care
Accessibility		0.86 (0.84, 0.88)^***	0.94 (0.92, 0.96)^***
Interpersonal Relationship		0.94 (0.93, 0.95)^***	0.94 (0.93, 0.96)^***
Covariates ^†
Sample size	58,956	36,743	36,743

* P < .5;
** P < .01;
*** P < .001.
† Covariates include sex, education, insurance coverage, smoke or not, employment status, and usual source of care type of place (age and employer type not included).
Note: Analysis for all models excluded the observations that have missing values in mental health status. Models II and III also excluded those who did not answer all 7 questions in regard to accessibility and interpersonal relationship of primary care.

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Table 2.

Multivariate Analysis of Vulnerability, Primary Care, and Mental Health Status (Odds Ratio (95% CI))

	Mental Health (Modeling 1 = Poor Mental Health)
	Model I	Model II	Model III
1996/1997
Vulnerability
White-Poverty	2.02 (1.84, 2.21)^***	2.09 (1.83, 2.37)^***	1.40 (1.22, 1.61)^***
White-above Poverty (ref)
Black-Poverty	2.80 (2.31, 3.41)^***	2.71 (2.12, 3.46)^***	1.61 (1.26, 2.05)^***
Black-above Poverty	1.32 (1.17, 1.49)^***	1.12 (1.00, 1.26)^*	1.03 (0.91, 1.16)
Hispanic-Poverty	1.57 (1.31, 1.87)^***	1.67 (1.29, 2.17)^***	0.98 (0.71, 1.34)
Hispanic-above Poverty	1.19 (1.09, 1.31)^***	1.12 (0.97, 1.28)	1.00 (0.82, 1.22)
Other-Poverty	2.13 (1.62, 2.81)^***	2.68 (1.93, 3.70)^***	1.78 (1.25, 2.53)^**
Other-above Poverty	1.18 (1.05, 1.34)^**	1.23 (1.06, 1.42)^**	1.13 (0.96, 1.34)
Primary Care
Accessibility		0.95 (0.93, 0.98)^***	0.92 (0.95, 0.99)^*
Interpersonal Relationship		0.92 (0.92, 0.93)^***	0.92 (0.92, 0.93)^***
Covariates^†
Sample size	49807	30492	30492

1998/1999
Vulnerability
White-Poverty	2.12 (1.83, 2.45)^***	2.23 (1.84, 2.69)^***	1.45 (1.20, 1.75)^***
White-above Poverty (ref)
Black-Poverty	2.70 (1.83, 2.45)^***	2.37 (1.92, 2.92)^***	1.21 (0.95, 1.55)
Black-above Poverty	1.38 (1.26, 1.51)^***	1.32 (1.18, 1.49)^***	1.21 (1.08, 1.36)^***
Hispanic-Poverty	2.19 (1.66, 2.88)^***	2.29 (1.74, 3.01)^***	1.33 (0.99, 1.79)
Hispanic-above Poverty	1.20 (1.08, 1.33)^***	1.15 (0.99, 1.33)	1.10 (0.94, 1.28)
Other-Poverty	2.35 (1.67, 3.31)^***	2.24 (1.40, 3.60)^***	1.44 (0.87, 2.38)
Other-above Poverty	1.03 (0.88, 1.21)	0.95 (0.80, 1.13)	0.84 (0.69, 1.01)
Primary Care
Accessibility		0.94 (0.92, 0.96)^***	0.96 (0.94, 0.98)^***
Interpersonal Relationship		0.93 (0.92, 0.94)^***	0.93 (0.92, 0.94)^***
Covariates ^†
Sample size	48724	30358	30358

* P < .5;
** P < .01;
*** P < .001.
† Covariates include sex, education, insurance coverage, smoke or not, employment status, and usual source of care type of place (age and employer type not included).
Note: Analysis for all models excluded the observations that have missing values in mental health status. Models II and III also excluded those who did not answer all 7 questions in regard to accessibility and interpersonal relationship of primary care.

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Table 3.

Bivariate Analysis of Vulnerability, Primary Care, and General Health Status

	1996/1997		1998/1999
	Good Health	Poor Health	Good Health	Poor Health
Race
White	89.19%	10.81%	89.18%	10.82%
Black	83.10%	16.90%	83.03%	16.97%
Hispanic	78.26%	21.74%	80.47%	19.53%
Other	85.96%	14.04%	87.08%	12.92%
CHISQ		83.5^***		77.9^***
Sample size		60446		58956

Vulnerability
White
Poverty	77.44%	22.56%	77.79%	22.21%
Above Poverty	90.55%	9.45%	90.37%	9.63%
Black
Poverty	75.72%	24.28%	74.76%	25.24%
Above Poverty	86.39%	13.61%	86.49%	13.51%
Hispanic
Poverty	69.12%	30.88%	70.66%	29.34%
Above Poverty	82.03%	17.97%	84.22%	15.78%
Other
Poverty	72.17%	27.83%	79.07%	20.93%
Above Poverty	89.14%	10.86%	88.67%	11.33%
CHISQ		150.16		176.77
Sample size		60446		58956

Primary Care
Accessibility	13.25	12.85	13.07	12.91
t test		13.59^***		6.09^***
Sample size		37592		37287
Interpersonal Relationship	16.72	15.74	16.80	15.91
t test		12.49^***		15.89^***
Sample size		44343		43721

*P < .5;
**P < .01;
*** P < .001.
Note: Distribution and t test for accessibility of primary care included those who answered all 3 questions on accessibility. Distribution and t test for interpersonal relationship included those who answered all 4 questions on interpersonal relationship.

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Table 4.

Bivariate Analysis of Vulnerability, Primary Care Experiences, and Mental Health Status

	1996/1997		1998/1999
	Good Health	Poor Health	Good Health	Poor Health
Race
White	78.22%	21.78%	79.16%	20.84%
Black	70.31%	29.69%	71.16%	28.84%
Hispanic	75.15%	24.85%	74.49%	25.51%
Other	74.57%	25.43%	77.22%	22.78%
CHISQ		32.53^***		61.03^***
Sample size		49807		48724

Vulnerability
White
Poverty	65.86%	34.14%	65.96%	34.04%
Above Poverty	79.57%	20.43%	80.43%	19.57%
Black
Poverty	58.16%	41.84%	60.38%	39.62%
Above Poverty	74.69%	25.31%	74.87%	25.13%
Hispanic
Poverty	71.31%	28.69%	65.26%	34.74%
Above Poverty	76.54%	23.46%	77.44%	22.56%
Other
Poverty	64.61%	35.39%	63.62%	36.38%
Above Poverty	76.68%	23.32%	79.92%	20.08%
CHISQ		178.12		162.86
Sample size		49807		48724

Primary Care
Accessibility	13.13	12.99	13.07	12.91
t test		4.39^***		6.09^***
Sample size		37592		37287
Interpersonal Relationship	16.74	15.75	16.80	15.91
t test		17.25^***		15.89^***
Sample size		44343		43721

*P < .5;
**P < .01;
*** P < .001
Note: Distribution and t test for accessibility of primary care included those who answered all 3 questions on accessibility. Distribution and t test for interpersonal relationship included those who answered all 4 questions on interpersonal relationship.