As the role of primary care physicians play an important role in controlling risk factors for coronary heart disease and stroke, the team hypothesized that longer road-distance to a primary care physician, which may be linked to poor primary care accessibility, may be a significant risk factor for death from stroke and/or ischemic heart disease. However, a new research has reported that longer road-distance to a primary care facility may increase the risk of stroke mortality.
The study results were only significant for stroke, but not ischemic heart disease. Stroke mortality in Japan is higher than ischemic heart disease mortality, and hypertension is a strong risk factor for stroke, 26 but to a lesser extent for ischemic heart disease.
Poor access to a primary care physician may lead to poor control of risk factors for disease. This study investigated whether geographic access to a primary care physician was related to ischemic heart disease and stroke mortality.
Road-distances from the centroids of the basic unit blocks of the 2010 Japanese Census to the nearest primary care facilities in Hokkaido, northern Japan, were measured using geographic information system (GIS) software.
Next, block population-weighted mean road-distances to primary care facilities in all municipalities were calculated. The numbers of deaths from ischemic heart disease and stroke were obtained from the Vital Statistics Bureau.
A Bayesian spatial conditional autoregressive (CAR) model was used to analyze relative risk (RR) by road-distance with the numbers of physicians in the municipality included as a covariate.
Relative risk (per 1 kilometer increased) of death from ischemic heart disease to road-distance to the nearest primary care facility was not significantly higher in men and women. However, RR of death from stroke was significantly higher in men and women.
In our results, 95% CIs of RRs for road-distance and stroke mortality among both men and women did not include, respectively, even after the number of physicians was introduced into the models as a potential cofounder, suggesting that risk of death from a stroke was significantly associated with longer road- distance to a primary health care facility. However, for ischemic heart disease, the 95% CI s included, suggesting no such statistically significant association