General practice organisation in France: ecological analysis of mortality and life expectancy

Background Access to general practitioners has become a major concern in many high-income countries, including France. Evidence suggests that primary care organisation is related to population health outcomes.

Aim This study aimed to analyse the association between the territorial organisation of healthcare and two population health indicators: all-cause mortality and life expectancy at birth.

Design & setting This is a cross-sectional ecological study using exhaustive French departmental data in 2021 (n=96). Data were obtained from public open-data sources. Outcomes were departmental all-cause mortality rate and life expectancy at birth.

Method Explanatory variables included GP density, hospital bed density, socio-economic indicators, and demographic characteristics. Adjusted multivariable linear regression models were estimated, with log-transformation of mortality rates.

Results After adjustment, each additional GP per 10 000 inhabitants was associated with an approximately 1% lower mortality rate (−0.010 on the log-mortality scale; 95% CI [−0.019, −0.001]; P=0.027) and a 0.233 year higher life expectancy (95% CI [0.145, 0.322]; P<0.001). Hospital bed density was positively associated with mortality but not with life expectancy. Higher poverty rates and greater proportions of individuals aged≥65 years or living with long-term conditions were negatively associated with health outcomes. Population density showed inconsistent associations.

Conclusion Greater GP availability was associated with lower mortality and higher life expectancy at the departmental level in France. These findings support the hypothesis that primary care organisation may be related to population health outcomes. However, causal inference cannot be established because of the ecological cross-sectional design.

MeSH mortality, life expectancy, primary health care, general practice, social determinants of health