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Neighborhood Socioeconomic Status and Primary Health Care: Usual Points of Access and Temporal Trends in a Major US Urban Area

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An Erratum to this article was published on 11 November 2016

Abstract

Neighborhood socioeconomic status (SES), an overall marker of neighborhood conditions, may determine residents’ access to health care, independently of their own individual characteristics. It remains unclear, however, how the distinct settings where individuals seek care vary by neighborhood SES, particularly in US urban areas. With existing literature being relatively old, revealing how these associations might have changed in recent years is also timely in this US health care reform era. Using data on the Philadelphia region from 2002 to 2012, we performed multilevel analysis to examine the associations of neighborhood SES (measured as census tract median household income) with access to usual sources of primary care (physician offices, community health centers, and hospital outpatient clinics). We found no evidence that residence in a low-income (versus high-income) neighborhood was associated with poorer overall access. However, low-income neighborhood residence was associated with less reliance on physician offices [−4.40 percentage points; 95 % confidence intervals (CI) −5.80, −3.00] and greater reliance on the safety net provided by health centers [2.08; 95 % CI 1.42, 2.75] and outpatient clinics [1.61; 95 % CI 0.97, 2.26]. These patterns largely persisted over the 10 years investigated. These findings suggest that safety-net providers have continued to play an important role in ensuring access to primary care in urban, low-income communities, further underscoring the importance of supporting a strong safety net to ensure equitable access to care regardless of place of residence.

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Acknowledgments

We thank Steve Melly at the Urban Health Collaborative for GIS assistance. No funding was specifically sought for this study. This study was presented at the American Public Health Association Annual Meeting in November 2015 in Chicago, IL.

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  1. Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA

    Mustafa Hussein, Ana V. Diez Roux & Robert I. Field

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  1. Mustafa Hussein
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Correspondence to Mustafa Hussein.

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An erratum to this article is available at http://dx.doi.org/10.1007/s11524-016-0095-0.

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Hussein, M., Diez Roux, A.V. & Field, R.I. Neighborhood Socioeconomic Status and Primary Health Care: Usual Points of Access and Temporal Trends in a Major US Urban Area. J Urban Health 93, 1027–1045 (2016). https://doi.org/10.1007/s11524-016-0085-2

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