Relationship between Physician Workforce Racial Diversity and Racial Disparities in County-Level Premature Deaths

Abstract

Background

Increasing physician workforce diversity has been touted as a means to improve population health outcomes and health equity. We sought to evaluate the association between physician workforce racial diversity and mortality using an ecological approach.

Methods

County-level data from 430 US counties were obtained and merged from three sources. Data on physician supply and racial mix were obtained from the 2016-2020 American Community Survey and aggregated at the county level. Information on county-level sociodemographic and economic factors, health services availability, and health outcomes were obtained from the 2022 County Health Rankings and the 2020-2021 Area Health Resource File. The dependent variable, premature death disparities, was measured as the ratio of the county-level premature death rate and the premature death rate for Whites. The key independent variable, physician workforce racial diversity, was measured as the proportion of Non-White physicians. We adjusted for several potential social determinants of health factors that could act as confounders. Data were analyzed using linear regression, and clustered standard errors were obtained at the state level. The statistical software used was Stata version 17, with statistical significance assessed at p<0.05.

Results

Physician workforce racial diversity was found to be negatively associated with disparities in premature deaths (b=-0.07; 95% CI=-0.13 to -0.01; p=0.03). Other factors negatively associated with disparities in county-level premature death included the uninsurance rate, high school graduation rate, and the proportion of the population to primary care physicians. Compared to the northeast, the midwest and southeast geographical regions were associated with increased disparities in premature deaths. A high proportion of females, income inequality and the number of hospitals in a county were also positively associated with disparities in premature deaths.

Conclusion

Physician workforce diversity may be essential to improving health disparities and advancing health equity.

Keywords

Workforce Diversity Obstetrics Disparities Mortality

This document is currently not available here.

Share

COinS
 

Relationship between Physician Workforce Racial Diversity and Racial Disparities in County-Level Premature Deaths

Background

Increasing physician workforce diversity has been touted as a means to improve population health outcomes and health equity. We sought to evaluate the association between physician workforce racial diversity and mortality using an ecological approach.

Methods

County-level data from 430 US counties were obtained and merged from three sources. Data on physician supply and racial mix were obtained from the 2016-2020 American Community Survey and aggregated at the county level. Information on county-level sociodemographic and economic factors, health services availability, and health outcomes were obtained from the 2022 County Health Rankings and the 2020-2021 Area Health Resource File. The dependent variable, premature death disparities, was measured as the ratio of the county-level premature death rate and the premature death rate for Whites. The key independent variable, physician workforce racial diversity, was measured as the proportion of Non-White physicians. We adjusted for several potential social determinants of health factors that could act as confounders. Data were analyzed using linear regression, and clustered standard errors were obtained at the state level. The statistical software used was Stata version 17, with statistical significance assessed at p<0.05.

Results

Physician workforce racial diversity was found to be negatively associated with disparities in premature deaths (b=-0.07; 95% CI=-0.13 to -0.01; p=0.03). Other factors negatively associated with disparities in county-level premature death included the uninsurance rate, high school graduation rate, and the proportion of the population to primary care physicians. Compared to the northeast, the midwest and southeast geographical regions were associated with increased disparities in premature deaths. A high proportion of females, income inequality and the number of hospitals in a county were also positively associated with disparities in premature deaths.

Conclusion

Physician workforce diversity may be essential to improving health disparities and advancing health equity.