Racial/ethnic disparities in access to primary care: a spatial approach to determining the effects of residential segregation, socioeconomic status and health factors on access to primary care in U.S. adults

This study builds on the existing literature on access to primary care and the associations between demographic, health, socioeconomic, and residential segregation variables and how minorities encounter higher disparities accessing primary care services. The study uses data from the Behavioral Risk Factor Surveillance System (BRFSS) from 2012. BRFSS City and County Data and Documentation (SMART) for 2012, American Community Service (ACS – 5-year estimates) at the county level, US Census Summary File 1 (SF1) at the Census tract level, American Fact Finder (DP2 – social characteristics- and DP3 – economic characteristics) summary tables at the tract level for the state of Texas from the 2005-2009 5 year ACS summary file and data from Texas Medical Board (TMB) licensed physician database from 2011. The key findings include, (1) racial/ethnic disparities are still present after controlling for demographic, socioeconomic, and health related characteristics on whether individuals had a personal doctor; (2) socioeconomic status, educational attainment especially, did not operate as expected; (4) individuals living in counties with income levels below poverty levels and with higher percentage with no high school education had lower odds of reporting a personal doctor; (5) residential segregation did not have any significant association with an individual’s access to primary care above and beyond individual- and county-level characteristics; (6) black residents living in black isolated neighborhoods or Hispanic residents living in Hispanic isolated neighborhoods had lower than average potential spatial access to primary care; (7) this varied by the catchment area used to calculate the accessibility indices.