The effect of primary care physician supply and income inequality on mortality among Blacks and Whites in US metropolitan areas

Objectives. This study assessed whether income inequality and primary care physician supply have a different effect on mortality among Blacks compared with Whites. Methods. We conducted a multivariate ecologic analysis of 1990 data from 27 3 US metropolitan areas. Results. Both income inequality and primary care physician supply were sign ificantly associated with White mortality (P <.01). After the inclusion of the socioeconomic status covariates, the effect of income inequality on Bla ck mortality remained significant (P<.01), but the effect of primary care p hysician supply was no longer significant (P>.10), particularly in areas wi th high income inequality. Conclusions. Improvement in population health requires addressing socioecon omic determinants of health, including income inequality and primary care a vailability and access.