Access to primary care physicians, race/ethnicity, and premature mortality: Analysis of 154,516 deaths in Washington State, United States

Aim: A vital benefit of primary care access is the attenuation of racial and ethnic disparities in mortality rates. The purpose of this study was to examine the associations between race/ethnicity, access to primary care physicians (PCP), and premature mortality among decedents in Washington State between 2015 and 2017. Methods: Data on registered deaths and supply of PCPs were obtained from the Washington State Department of Health and American Medical Association, respectively. Multilevel binary logistic regression models were applied to examine the association of access to PCP, race, and premature mortality. Results: Average distance to the closest five PCPs was 3 miles. American Indian/Alaska Natives would have had to travel on average 6 miles one-way to reach the nearest PCPs, while people of other racial and ethnic groups would have had to travel between 1 and 3 miles. The odds of premature mortality was 4% higher per unit increase in distance to the closest PCPs. The positive relationship between distance to PCPs and premature mortality was weaker for American Indian/Alaska Natives, stronger for White and Asian people, and not statistically significant for Black and Hispanic people. Conclusion: Increasing access to PCPs, as well as further exploration in understanding, identifying, and alleviating reasons that may lead racial and ethnic minorities to underutilize PCP services are warranted.