Primary care, income inequality, and self-rated health in the United States: a mixed-level analysis

Int J Health Serv. 2000;30(3):541-55. doi: 10.2190/N4M8-303M-72UA-P1K1.


Using the 1996 Community Tracking Study household survey, the authors examined whether income inequality and primary care, measured at the state level, predict individual morbidity as measured by self-rated health status, while adjusting for potentially confounding individual variables. Their results indicate that distributions of income and primary care within states are significantly associated with individuals' self-rated health; that there is a gradient effect of income inequality on self-rated health; and that individuals living in states with a higher ratio of primary care physician to population are more likely to report good health than those living in states with a lower such ratio. From a policy perspective, improvement in individuals' health is likely to require a multi-pronged approach that addresses individual socioeconomic determinants of health, social and economic policies that affect income distribution, and a strengthening of the primary care aspects of health services.

Publication types

  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Catchment Area, Health / statistics & numerical data
  • Family Characteristics
  • Female
  • Health Status Indicators*
  • Health Surveys
  • Humans
  • Income / classification*
  • Income / statistics & numerical data
  • Male
  • Middle Aged
  • Morbidity
  • Poverty / statistics & numerical data
  • Primary Health Care / statistics & numerical data*
  • Self Efficacy
  • United States / epidemiology