Primary care characteristics, individual health status, racial and ethnic disparities, and income inequality

Objective. The objective of this dissertation was to examine the role of individual primary care characteristics in decreasing racial and ethnic health disparities and in mediating the likely adverse relationship between state income inequality and individual health.; Methods. Comprehensive review of literature on the relationships among primary care, health outcomes, racial and ethnic health disparities, and income inequality was conducted to evaluate accumulated research evidence on these relationships. A longitudinal analysis of repeated measurements of individual self-reported health status from the 1996–97 Medical Expenditure Panel Survey was performed with application of population-averaged and multilevel logistic models. The main explanatory variables included individual assessments of primary care characteristics (i.e., accessibility, continuity, comprehensiveness, and coordination), race/ethnicity, and state income inequality. The analyses controlled for individual socioeconomic and demographic characteristics.; Results. Significant racial and ethnic disparities in self-reported health were confirmed but varied by age group. Primary care characteristics of accessibility, continuity, and interpersonal relationship were found to be significantly associated with self-reported health status and also with partial attenuation of racial health disparities of the black elderly population. Significant negative association between state-level income inequality and individual health was confirmed after controlling for individual income and other individual determinants of health. Partial mediating effect of accessibility of a usual source of care on the adverse relationship between state income inequality and individual health was found.; Conclusions. Primary care characterized by good accessibility and continuity contributes to better health of the American population, mitigates racial and ethnic health disparities, and decreases the negative influence of social inequalities on health. Further research based longitudinal assessments of both individual health status and primary care characteristics is needed to provide stronger inferences on causal relationships.