Background: Several studies have shown that people living in areas underserved in physicians have reduced odds of consulting. However, beyond the magnitude of this effect averaged for the whole population, policymakers need to know whether specific subgroups faced with transportation difficulties, such as the elderly and especially the disabled elderly, have a particularly restricted access to physicians when residing in underserved areas. Methods: The study sample, representative of the French population aged 18-75 in 1999, comprised 12 405 individuals. Multilevel Poisson models were used to investigate the impact of the area-level density of general practitioners (GPs) on the number of GP consultations reported over the previous 12 months. Results: The mean number of GP consultations over the previous 12 months was 3.8 (S.D.=4.9). Multivariate analyses indicated that living in areas underserved in GPs lead to a greater reduction in primary care utilization for the elderly, and especially for the disabled elderly, than for younger age groups. The disabled elderly had 244% more GP consultations (95% CI:+79%, +562%) when they lived in areas with high versus low GP density (defined with the 10th and 90th percentiles as cut-offs). Conclusion: If further research confirms our findings, this increasingly disturbing public health issue in industrialized countries where populations are ageing will require priority policy measures. Ensuring that elderly people living in underserved areas have adequate access to primary care may prevent future hospitalizations, use of home care services and institutionalization.
