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

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.