Higher Density of Primary Care Facilities Is Inversely Associated with Ischemic Heart Disease Mortality, but Not with Stroke Mortality: A Japanese Secondary Medical Service Area Level Ecological Count Data

YASUAKI SAIJO,¹ EIJI YOSHIOKA¹ and YUKIHIRO SATO¹

¹Division of Public Health and Epidemiology, Department of Social Medicine, Asahikawa Medical University, Asahikawa, Hokkaido, Japan

Poor accessibility to physicians might be linked to the inadequate control of cardiovascular risk factors. The aim of this study was to investigate whether the accessibility of primary care physicians was related to a lower incidence of ischemic heart disease and stroke mortality via ecological data analyses of both primary care facility density and internal physician density. The unit of observation was the Japanese secondary medical service area, the basic unit for healthcare planning and administration. A primary care facility was defined as a clinic or medical institution with less than 200 inpatient beds, whose specialty included internal medicine. The number of primary care facilities per 10,000 population and the number of internal physicians per 10,000 population were used as explanatory variables. Bayesian hierarchical models were used to analyze the relative risks (RR) of primary care facility density and internal physician density using the socioeconomic confounders of designated emergency hospitals, natural log-transformed population density, birth rate, secondary and tertiary industrial workers, and taxable income. In multivariate models for ischemic heart disease mortality, primary care facility density was significantly related to the total population (RR = 0.986, 95% credible interval [CrI]: 0.979-0.993), men (RR = 0.988, 95% CrI: 0.981-0.996), and women (RR = 0.986, 95% CrI: 0.979-0.993). No significant results were obtained for internal physician density. In the multivariate models for stroke mortality, neither primary care facility density nor internal physician density showed any significant effects. Increasing primary care facility density may reduce ischemic heart disease mortality.

Keywords —— integrated nested Laplace approximation; internal physician; ischemic heart disease; primary care facility; stroke

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Tohoku J. Exp. Med., 2020 July, 251(3), 217-224.

Correspondence: Yasuaki Saijo, M.D., Ph.D., Division of Public Health and Epidemiology, Department of Social Medicine, Asahikawa Medical University, 2-1-1-1 Midorigaoka-higashi, Asahikawa, Hokkaido 078-8510, Japan.

e-mail: y-saijo@asahikawa-med.ac.jp