Access to Primary Care in US Counties Is Associated with Lower Obesity Rates

Gaglioti, Anne H.; Petterson, Stephen; Bazemore, Andrew; Phillips, Robert L.

doi:10.3122/jabfm.2016.02.150356

Cited by 18 publications

(12 citation statements)

References 39 publications

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“…Yet with our findings, primary care clinicians, overwhelmed by the burdens of treating patients with severe obesity, can be encouraged that simply offering greater contact to patients with severe obesity improves weight loss. In addition, our findings lend support to the call for improved primary care access, and thus more office visits, for patients with severe obesity as they have shown to be at risk for inferior primary care access and preventive care [10,11]. The next reasonable study would tease out how and why patients with severe obesity lose more weight when they have more visits with their primary care clinicians.…”

Section: Discussionsupporting

confidence: 65%

When More is Better: Impact of Primary Care Office Visits on Severe Obesity

Rao¹,

Bartfield²

2016

Gen Med (Los Angeles)

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Background: Among patients with obesity, the subset of patients with severe obesity has been increasing at the fastest rate. Although there is literature which suggests modest effectiveness of weight loss counselling by primary care providers, many primary care clinicians face frustration with the management of obesity. Reasons for this include time constraints, poor reimbursement, and perceived inadequacy or futility of obesity treatments. Despite these obstacles, we hypothesize that primary care clinicians still positively impact weight loss for patients with severe obesity.

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Section: Discussionsupporting

confidence: 65%

When More is Better: Impact of Primary Care Office Visits on Severe Obesity

Rao¹,

Bartfield²

2016

Gen Med (Los Angeles)

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“…Regarding the inverse correlation of major CVD prevalence with the number of cardiologists, previous studies have reported possible explanations. They have described that higher physician density could improve specific health outcomes ( 7 , 8 ). With a higher density, each physician likely has to care for fewer patients, the patients have more alternatives and they have to travel shorter distances.…”

Section: Discussionmentioning

confidence: 99%

“…A Japanese study similarly found a negative association between pediatrician density and mortality of under 5-year-olds ( 6 ). Several other studies have noted that greater primary care physician supply is associated with improvements in health outcomes such as obesity rates ( 7 , 8 ).…”

Section: Introductionmentioning

confidence: 99%

Prevalence, Mortality, and Indicators of Health Care Supply—Association Analysis of Cardiovascular Diseases in Germany

Dornquast

Willich

Reinhold

2018

Front. Cardiovasc. Med.

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Introduction: There are regional differences in the morbidity of major cardiovascular disease between the 16 federal states of Germany. An association between the morbidity and the health care supply has been described in international studies. The aim of the present analysis was to examine the relationship between the prevalence or mortality of major cardiovascular disease and several key indicators of health care supply in Germany.Methods: Life expectancy and the proportion of over 65-year old persons were included as characteristics to depict the general health. Indicators of health care supply were the number of general practitioners, internists, and cardiologists, number of internal medicine and cardiology beds, chest pain units (CPU), cardiac catheterization laboratories (CCL) and stroke units. In the form of an ecological analysis, we compared the cardiovascular disease prevalence and mortality with these indicators and performed a weighted linear regression.Results: Regional variations between the federal states were found in general health and health care supply. The regression analysis yielded significant associations of the prevalence of major cardiovascular disease with the number of internal medicine hospital beds (β = 10.042, p = 0.045), cardiologists (β = −0.689, p = 0.031), and the number of residents per chest pain unit (β = 42,730, p = 0.036). Additionally, the relationship between cardiovascular mortality and also the number of residents per chest pain unit appeared to be significant (β = 4,962, p = 0.002). For all other indicators, no significant association was observed.Conclusions: We detected regional differences in the general health and health care supply between the 16 German federal states as well as several significant associations between cardiovascular morbidity and health care supply indicators. Especially the decreasing number of cardiologists and rising number of residents per chest pain unit with an increasing prevalence of major cardiovascular disease should lead to a discussion about the structure of the Germany health care system, such as the needs-based planning mechanism of physicians. The results of this study may also aid in future development of other health care systems.

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“…Consistent with Siddiqi et al we find that there are cross-national differences in the prevalence of morbid obesity, in the shape of the socioeconomic distribution and the absolute and relative magnitude of inequalities ( Siddiqi et al, 2015 ). Inequalities in income and education may influence health via multiple downstream mediators including, but not restricted to, lifestyle choices, diet quality and access to resources for physical activity ( Benach & Muntaner, 2007 ; Devaux, 2013 ; Devaux & Sassi, 2013 ; Gaglioti, Petterson, Bazemore & Phillips, 2016 ). Educational attainment is generally expected to be associated with higher income but this effect may be modified by other characteristics including age-group, ethnicity and gender ( Braveman, Cubbin & Egerter, 2005 ).…”

Section: Discussionmentioning

confidence: 99%

Socioeconomic inequality in morbid obesity with body mass index more than 40 kg/m2 in the United States and England

Booth

Charlton

Gulliford

2017

SSM - Population Health

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IntroductionThis study evaluated socioeconomic inequality in morbid obesity (body mass index, BMI ≥40 kg/m2) through an analysis of population health survey data in the United States (US) and England (UK).MethodsWe analysed data for the National Health and Nutrition Examination Survey and the Health Survey for England for 2011 to 2014. Age-adjusted odds ratios (AOR) were used to evaluate income- and education-inequality.ResultsThere were 26,898 eligible UK and 10,628 US participants. Morbid obesity was more frequent in women than men, and higher in the US than the UK (men: US, 4.8%; UK, 1.7%; women US, 9.6%; UK, 3.7%). In the UK, morbid obesity showed graded income-inequality in both genders (AOR, for lowest income quintile: men, 1.83, 95% confidence interval 1.16 to 2.88; women, 2.18, 1.55 to 3.07), as well as education-inequality (AOR for no school qualifications, men 2.57, 1.64 to 4.02; women, 2.18, 1.55 to 3.07). In the US, morbid obesity showed a consistent gradient only for income in women (AOR for lowest income quintile 1.97, 1.19 to 3.25). When compared with all other US groups, having college education (AOR, men, 0.56, 0.29 to 1.08; women, 0.36, 0.22 to 0.60) or household income ≥$75 000 (AOR, men 0.52, 0.27 to 0.98; women, 0.51, 0.33 to 0.80) appeared to protect against morbid obesity.ConclusionsMorbid obesity is associated with lower socioeconomic status in men and women in the UK. In the US, morbid obesity was twice as prevalent, but less strongly associated with socioeconomic status, suggesting that morbid obesity may now have spread to all but the highest socioeconomic groups.

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Access to Primary Care in US Counties Is Associated with Lower Obesity Rates

Cited by 18 publications

References 39 publications

When More is Better: Impact of Primary Care Office Visits on Severe Obesity

When More is Better: Impact of Primary Care Office Visits on Severe Obesity

Prevalence, Mortality, and Indicators of Health Care Supply—Association Analysis of Cardiovascular Diseases in Germany

Socioeconomic inequality in morbid obesity with body mass index more than 40 kg/m2 in the United States and England

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