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

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.