Geographic Access to Primary Care and Racial and Ethnic Disparities in the Prevalence of Maternal Chronic Conditions 2020-2024.

IF 5.6 3区医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Preventing Chronic Disease Pub Date : 2026-10-15 DOI:10.5888/pcd23.260235

Sheree Boulet, Lauren Costley, Kaitlyn Stanhope

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引用次数: 0

Abstract

Introduction: Unequal access to preventive health care before and between pregnancies contributes to risk for adverse perinatal outcomes. Few studies have examined access to primary care as a contributor to racial and ethnic disparities in chronic disease prevalence among women having a live birth.

Methods: We linked 2020-2024 natality data with Health Resources and Services Administration's Area Health Resource Files and used spatial Bayesian conditional autoregressive models to estimate county-level associations between geographic access to primary care and prevalence of chronic conditions (obesity, hypertension, and diabetes) in 1,374 counties in the contiguous US. We defined geographic access to primary care using the Health Resources and Services Administration's primary care Health Professional Shortage Area (HPSA) designation and the number of primary care providers per 100,000 persons in quartiles. We assessed racial disparities in outcomes by modeling the difference in rate differences and 95% CIs among non-Hispanic Black and non-Hispanic White women having a live birth, controlling for county characteristics.

Results: Residing in a county designated as a primary care HSPA or with lower rates of density of primary care providers was associated with modestly increased prevalence of obesity and hypertension but not diabetes. However, across the chronic conditions, the disparity between non-Hispanic Black and non-Hispanic White women was generally consistent regardless of geographic access to primary care. For example, the rate difference between the 2 groups for obesity was 11.3 (95% CI, 10.5-12.0) per 100 births for primary care HPSAs and 9.9 (95% CI, 9.5-10.4) per 100 births for non-primary care HPSAs, while the adjusted β for the difference in rate differences was 0.005 (95% CI, -0.005 to 0.014).

Conclusion: Geographic access to primary care did not attenuate racial disparities in the prevalence of chronic conditions among women who had a live birth.

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初级保健的地理可及性以及2020-2024年孕产妇慢性病患病率的种族和民族差异

导言：怀孕前和怀孕之间获得预防性保健的机会不平等，增加了围产期不良后果的风险。很少有研究审查获得初级保健是造成活产妇女慢性病患病率的种族和族裔差异的原因。方法：我们将2020-2024年出生数据与卫生资源和服务管理局的区域卫生资源文件联系起来，并使用空间贝叶斯条件自回归模型来估计美国1374个县的初级保健地理可及性与慢性病（肥胖、高血压和糖尿病）患病率之间的县级关联。我们使用卫生资源和服务管理局的初级保健卫生专业人员短缺区域（HPSA）指定和每10万人中初级保健提供者的四分位数来定义初级保健的地理可及性。我们通过模拟非西班牙裔黑人和非西班牙裔白人妇女活产率差异和95% ci的差异来评估结果的种族差异，控制县特征。结果：居住在指定为初级保健HSPA的县或初级保健提供者密度较低的县与肥胖和高血压的患病率适度增加有关，但与糖尿病无关。然而，在慢性疾病中，非西班牙裔黑人和非西班牙裔白人妇女之间的差异总体上是一致的，无论地理位置如何获得初级保健。例如，两组之间的肥胖率差异在初级保健高脂人群中为每100例分娩11.3例（95% CI, 10.5-12.0），在非初级保健高脂人群中为每100例分娩9.9例（95% CI, 9.5-10.4），而调整后的β值为0.005 （95% CI, -0.005 - 0.014）。结论：获得初级保健的地理位置并没有减弱活产妇女慢性疾病患病率的种族差异。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Preventing Chronic Disease PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH-

CiteScore

6.70

自引率

3.60%

发文量

期刊介绍： Preventing Chronic Disease (PCD) is a peer-reviewed electronic journal established by the National Center for Chronic Disease Prevention and Health Promotion. The mission of PCD is to promote the open exchange of information and knowledge among researchers, practitioners, policy makers, and others who strive to improve the health of the public through chronic disease prevention. The vision of PCD is to be the premier forum where practitioners and policy makers inform research and researchers help practitioners and policy makers more effectively improve the health of the population. Articles focus on preventing and controlling chronic diseases and conditions, promoting health, and examining the biological, behavioral, physical, and social determinants of health and their impact on quality of life, morbidity, and mortality across the life span.