Studies considering underserved urban location are more challenging with secondary data. Unlike rural areas where a single zip code may define a geographic area, urban areas have multiple overlapping zip codes shared by major medical centers, underserved locations, and urban served locations. Also lower and middle income white, black, and Hispanic medical students are assigned a higher income level by the birth county income assignment process.
Studies of urban underserved locations need direct individual data for best result.
Estimates can be made using logistic regression however.
Logistic Regression on Urban Underserved Location for US MD Grads
|
|
B |
Std. Error |
Wald |
df |
Sig. |
Exp(B) |
95% Confidence Interval for Exp(B) |
|
|
|
|
|
|
|
|
Odds Ratios |
Lower Bound |
Upper Bound |
|
Intercept |
0.3813 |
0.17 |
5.169 |
1 |
0.022999 |
|
|
|
|
Younger than 26 years |
-0.155 |
0.06 |
6.872 |
1 |
0.008753 |
0.8563 |
0.7625 |
0.9616 |
|
Top MCAT 20 schools |
-0.146 |
0.04 |
11.07 |
1 |
0.000877 |
0.8643 |
0.7932 |
0.9418 |
|
Top Quartile Income |
-0.041 |
0.04 |
1.313 |
1 |
0.251842 |
0.9594 |
0.8937 |
1.0299 |
|
MS County City |
0.0256 |
0.03 |
0.627 |
1 |
0.428417 |
1.0259 |
0.963 |
1.093 |
|
Public School |
0.2245 |
0.03 |
47.14 |
1 |
6.61E-12 |
1.2517 |
1.174 |
1.3345 |
|
Obstetrics Gynecology |
0.2509 |
0.06 |
20.55 |
1 |
5.81E-06 |
1.2852 |
1.1531 |
1.4325 |
|
Older than 29 Yrs Grad |
0.2612 |
0.03 |
73.33 |
1 |
1.1E-17 |
1.2985 |
1.2232 |
1.3786 |
|
Office Internal Medicine |
0.2927 |
0.04 |
44.42 |
1 |
2.65E-11 |
1.3401 |
1.2295 |
1.4605 |
|
Bottom Income Quartile |
0.2936 |
0.04 |
51.72 |
1 |
6.41E-13 |
1.3412 |
1.2381 |
1.453 |
|
Foreign Born |
0.3167 |
0.04 |
65.09 |
1 |
7.15E-16 |
1.3726 |
1.271 |
1.4824 |
|
Office Pediatrics |
0.4959 |
0.05 |
99.81 |
1 |
1.68E-23 |
1.642 |
1.4898 |
1.8097 |
|
Family Medicine |
0.7453 |
0.03 |
460.5 |
1 |
3.7E-102 |
2.1071 |
1.9685 |
2.2556 |
|
Historically Black School |
1.0498 |
0.08 |
156.2 |
1 |
7.57E-36 |
2.8572 |
2.4235 |
3.3685 |
Graduates of Historically Black medical schools have the greatest probability of distribution at nearly 3 times odds ratios. A similar pattern of increased underserved distribution is found for black, Hispanic, Native, and others different in income and social status in studies of family physicians. Family medicine retains a doubling impact on urban underserved distribution. Other primary care areas also maintain higher levels of urban underserved distribution. Older graduates and public medical schools increase distribution and younger graduates and those of higher income or higher MCAT medical school have lower levels of urban underserved distribution.
The odds ratios indicate ethnicity, race, and birth factors are important for health care in predominantly black rural counties as well.
Ethnicity, Gender, Admissions, and Distribution of Physicians
Role of Black and Hispanic Physicians Volume 334
Changes in Admissions in Allopathic Medical Schools