Primary care doctors make a difference in stroke deaths

American Heart Association
Friday, 4 July 2003

More primary care physicians may result in fewer stroke deaths, according to a study in today's rapid access issue of Stroke: Journal of the American Heart Association.

On average, an increase of one primary care doctor per 10,000 population was associated with 1.5 fewer stroke deaths per 100,000, says lead author Leiyu Shi, Dr.P.H., an associate professor in the Department of Health Policy and Management at Johns Hopkins Bloomberg School of Public Health in Baltimore, Maryland.

This result holds even after controlling for "income inequality." Income inequality is a measure of the income gap between rich and poor people in a specific geographic area. It may affect health through psychosocial factors. Some theorize that disparities in income and social standing create stresses that can eventually damage health. For example, poorer people may have more hypertension and weight gain, and they may smoke more – factors, which exacerbate stroke risk.

"The study results also suggest that primary care reduces the impact of income inequality on stroke mortality," he says. "Public policy makers should target areas of income inequality for more primary care."

In the United States, socioeconomic status is a major determinant of a person's health. Greater income disparity is associated with poorer health, Shi says.

Researchers reviewed 11 years of U.S. state-level data from various sources including the Census Bureau, the Centers for Disease Control and Prevention and the American Medical Association. Researchers defined primary care physicians as those in family practice, general practice, general internal medicine and general pediatrics who are active in office-based patient care.

They found that the presence of primary care is associated with improvements in health and reductions in stroke death over time, despite worsening economics or lower levels of education – two factors previously linked to eroding health status.

In the analysis, the average state age-adjusted stroke death rate dropped about 17 percent between 1985 and 1995. During the same period the number of primary care physicians steadily increased, from 5.02 to 6.04 per 10,000 population. Income inequality fluctuated during this period, with an overall worsening trend.

The reasons for the association between the presence of primary care physicians and the drop in stroke deaths may be new stroke prevention and treatment strategies that have become more common in primary care practice, the researchers say. Those developments include better management of high blood pressure with new medications, improved treatments for heart attack survivors and attention to lifestyle-related risk factors.

Shi cautions that the results don't necessarily imply that the mere presence of more primary care physicians ensures that more people are exposed to primary care or that they receive superior care.

"Although the availability of primary care is by no means a substitute for socioeconomic status or higher income," adds Shi, "it is certainly another means to improve population health."

Co-authors are James Macinko, Ph.D.; Barbara Starfield, M.D., M.P.H.; Jiahong Xu; and Robert Politzer, Sc.D.

For more information, or to contact American Heart Association, see their website at: www.americanheart.org