Black Primary Care Doctor Representation Linked to Longer Life Expectancy

Credit: Pexels / Jeff Denlea

Though Black primary care physician representation was still lacking in more than half of all Census-defined US counties as of 2019, the rate of Black representation among primary care physicians has risen since 2009—and it’s been positively associated with longevity among Black individuals.¹

New longitudinal cohort analysis data from investigators at the Department of Health and Human Services (HHS) showed that Black primary care physicians were operating in more than 1300 US counties in 2019—a 9.8% increase from just 10 years prior. What’s more, Black primary care workforce representation was associated with reduction in all-cause mortality as well as an added life expectancy of 1 month among Black individuals in these counties.

The findings emphasize the continued need for diversity, inclusion and equity in continued care modalities like primary care, where physicians may have more opportunity to help prevent chronic diseases and relevant health events that drive race-based health disparities in the US.

John E. Snyder, MD, MS, MPH, and Rachel D. Upton, PhD, of the HHS Office of Planning, Analysis and Evaluation, led colleagues in their assessment of correlations between Black representation in the primary care workforce and the health outcomes of Black individuals. Prior research has linked primary care service availability and improved population health—though access to such continued care options is disparate in the US, “partly due to an insufficient number and uneven distribution of primary care physicians.”

“Patients in the health care safety net—that is, those with geographic, financial, insurance-related, linguistic, racism- or discrimination-related, and other barriers—experience disproportionate difficulties in accessing primary care and other essential health services,” investigators wrote. “While primary care availability appears to be important for everyone, some studies stratified by race suggest that there may be a more powerful inverse association between access and mortality for Black individuals.”

Snyder, Upton and colleagues interpreted Black primary care physician workforce representation with survival outcomes for US counties at established time points at 2009, 2014, and 2019. They defined county-level representation by the ratio of primary care physicians who self-identified as Black, divided by the proportion of the Black population.

They sought a main outcome of the effect of Black primary care physician representation on life expectancy and all-cause mortality among Black individuals, as well as disparities in mortality rates between Black and White individuals in such counties with or without Black primary care representation.

The team’s final analysis included a combined sample of 1618 US counties wherein ≥1 Black primary care physician operated during ≥1 time point. Black primary care physician representation increased gradually among US counties at each time point:

• 1198 counties in 2009
• 1260 counties in 2014
• 1308 counties in 2019

Despite the 9.8% increase over the decade, Black primary care physicians only operated in 41.6% of the Census-defined 3142 US counties as of 2019. The median workforce ratio increased from 0.69 (95% CI, 0.63 – 0.74) in 2009 to 0.85 (95%, 0.80 – 0.92) in 2019.

Based on the dependent outcome variable of Black primary care physician workforce representation, mean Black life expectancy at birth gradually increased from 76.64 in 2009 to 77.12 in 2019. The median mortality rate disparity between Black and White individuals decreased gradually from 1.13 (95%, 1.11 – 1.15) to 1.10 (95% CI, 1.08 – 1.12).

Based on a mixed-effects growths model, a 10% increase in Black primary care physician representation was associated with a life expectancy increase of 30.61 days for Black individuals (95% CI, 19.13 – 42.44).

Investigators concluded their study showed a direct link between improved Black individual life expectancy, mortality rates and mortality rate disparities versus White individuals, and US counties with Black primary care physicians.

“Hence, Black representation levels likely have relevance for population health, supporting the need to expand the structural diversity of the health workforce,” they wrote. “Future investigations may examine the likely myriad factors behind this finding, the extent to which physician-patient racial concordance plays a role in this observation, and the effects that efforts to diversify the health workforce ultimately have on population health.”

References

1. ^{Snyder JE, Upton RD, Hassett TC, et al. Black Representation in the Primary Care Physician Workforce and Its Association With Population Life Expectancy and Mortality Rates in the US. JAMA Network Open. 2023;6(4):e236687. doi:10.1001/jamanetworkopen.2023.6687}