Racial and Social Disparities in Primary Healthcare Access and Wait Times in Canada: A Cross-Sectional Study.

BACKGROUND: Having a primary healthcare provider (PHCP) is consistently associated with better health outcomes in both prevention and disease management. This study aimed to evaluate the association between racial/ethnocultural background and two key dimensions of primary healthcare access in Canada-having a PHCP and wait times for appointments-while accounting for unmet care needs and demographic, systemic, and socioeconomic factors. METHODS: An analysis of three cycles of the Canadian Community Health Survey (2015-16, 2017-18, and 2019-20) was conducted. Outcomes included: (1) having a PHCP; (2) waiting > 3 days for an appointment for a minor health concern; and (3) waiting > 6 days for such an appointment. Multivariable Poisson regression models were estimated, with covariates entered hierarchically across four stages. RESULTS: Access to a PHCP increased modestly from 83.6% in 2015-16 to 85.6% in 2019-20, but disparities by racial/ethnocultural background remained stable. After full adjustment, individuals identifying as Black, Chinese, or Indigenous were significantly less likely to report having a PHCP than those identifying as White (adjusted prevalence ratio [aPR] 0.97, 0.98, and 0.95, respectively). Individuals identifying as Black (aPR 0.83), Chinese (aPR 0.89), South Asian/Arab/West Asian (aPR 0.77), and other racial/ethnocultural groups (aPR 0.85) were less likely than White individuals to wait more than 3 days; individuals with multiple racial/ethnocultural origins and those identifying as Indigenous did not differ significantly from White individuals. Additionally, individuals identifying as homosexual or bisexual were more likely to wait more than 3 days (aPR 1.13) and more than 6 days (aPR 1.14) compared with heterosexual individuals. CONCLUSION: Despite Canada's universal health insurance, persistent racial/ethnocultural disparities in primary healthcare access remain. Indigenous individuals across all age groups, as well as Black and Chinese populations among those aged 18-40 years, continue to experience lower attachment to a PHCP. The shorter wait times observed among some racialized groups should be interpreted cautiously and not as evidence of more equitable access to primary healthcare, as wait times were assessed only among respondents who reported having a regular PHCP.